hospital_name,last_updated_on,version,hospital_location,hospital_address,license_number|LA,"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.",,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,
Morehouse General Hospital,1/1/2025,2.0.0,Morehouse General Hospital,"323 W. Walnut Avenue Bastrop, LA 71220",726011528,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 MEDICAID|MEDICAID|negotiated_dollar,standard_charge|AETNA MEDICAID|MEDICAID|negotiated_percentage,standard_charge|AETNA MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|AETNA MEDICAID|MEDICAID,standard_charge|AETNA MEDICAID|MEDICAID|methodology,additional_payer_notes|AETNA MEDICAID|MEDICAID,standard_charge|AETNA MEDICAID CHIP|MEDICAID|negotiated_dollar,standard_charge|AETNA MEDICAID CHIP|MEDICAID|negotiated_percentage,standard_charge|AETNA MEDICAID CHIP|MEDICAID|negotiated_algorithm,estimated_amount|AETNA MEDICAID CHIP|MEDICAID,standard_charge|AETNA MEDICAID CHIP|MEDICAID|methodology,additional_payer_notes|AETNA MEDICAID CHIP|MEDICAID,standard_charge|AETNA MEDICAID QHP|MEDICAID|negotiated_dollar,standard_charge|AETNA MEDICAID QHP|MEDICAID|negotiated_percentage,standard_charge|AETNA MEDICAID QHP|MEDICAID|negotiated_algorithm,estimated_amount|AETNA MEDICAID QHP|MEDICAID,standard_charge|AETNA MEDICAID QHP|MEDICAID|methodology,additional_payer_notes|AETNA MEDICAID QHP|MEDICAID,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|BCBS HMO|COMMERCIAL|negotiated_dollar,standard_charge|BCBS HMO|COMMERCIAL|negotiated_percentage,standard_charge|BCBS HMO|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS HMO|COMMERCIAL,standard_charge|BCBS HMO|COMMERCIAL|methodology,additional_payer_notes|BCBS HMO|COMMERCIAL,standard_charge|BCBS PPO|COMMERCIAL|negotiated_dollar,standard_charge|BCBS PPO|COMMERCIAL|negotiated_percentage,standard_charge|BCBS PPO|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS PPO|COMMERCIAL,standard_charge|BCBS PPO|COMMERCIAL|methodology,additional_payer_notes|BCBS PPO|COMMERCIAL,standard_charge|BCBS TRADITIONAL|COMMERCIAL|negotiated_dollar,standard_charge|BCBS TRADITIONAL|COMMERCIAL|negotiated_percentage,standard_charge|BCBS TRADITIONAL|COMMERCIAL|negotiated_algorithm,estimated_amount|BCBS TRADITIONAL|COMMERCIAL,standard_charge|BCBS TRADITIONAL|COMMERCIAL|methodology,additional_payer_notes|BCBS TRADITIONAL|COMMERCIAL,standard_charge|HUMANA COMMERCIAL EPO|MEDICARE|negotiated_dollar,standard_charge|HUMANA COMMERCIAL EPO|MEDICARE|negotiated_percentage,standard_charge|HUMANA COMMERCIAL EPO|MEDICARE|negotiated_algorithm,estimated_amount|HUMANA COMMERCIAL EPO|MEDICARE,standard_charge|HUMANA COMMERCIAL EPO|MEDICARE|methodology,additional_payer_notes|HUMANA COMMERCIAL EPO|MEDICARE,standard_charge|HUMANA COMMERCIAL EPOX|MEDICARE|negotiated_dollar,standard_charge|HUMANA COMMERCIAL EPOX|MEDICARE|negotiated_percentage,standard_charge|HUMANA COMMERCIAL EPOX|MEDICARE|negotiated_algorithm,estimated_amount|HUMANA COMMERCIAL EPOX|MEDICARE,standard_charge|HUMANA COMMERCIAL EPOX|MEDICARE|methodology,additional_payer_notes|HUMANA COMMERCIAL EPOX|MEDICARE,standard_charge|HUMANA COMMERCIAL HMO|MEDICARE|negotiated_dollar,standard_charge|HUMANA COMMERCIAL HMO|MEDICARE|negotiated_percentage,standard_charge|HUMANA COMMERCIAL HMO|MEDICARE|negotiated_algorithm,estimated_amount|HUMANA COMMERCIAL HMO|MEDICARE,standard_charge|HUMANA COMMERCIAL HMO|MEDICARE|methodology,additional_payer_notes|HUMANA COMMERCIAL HMO|MEDICARE,standard_charge|HUMANA COMMERCIAL HMOX|MEDICARE|negotiated_dollar,standard_charge|HUMANA COMMERCIAL HMOX|MEDICARE|negotiated_percentage,standard_charge|HUMANA COMMERCIAL HMOX|MEDICARE|negotiated_algorithm,estimated_amount|HUMANA COMMERCIAL HMOX|MEDICARE,standard_charge|HUMANA COMMERCIAL HMOX|MEDICARE|methodology,additional_payer_notes|HUMANA COMMERCIAL HMOX|MEDICARE,standard_charge|HUMANA COMMERCIAL POS|MEDICARE|negotiated_dollar,standard_charge|HUMANA COMMERCIAL POS|MEDICARE|negotiated_percentage,standard_charge|HUMANA COMMERCIAL POS|MEDICARE|negotiated_algorithm,estimated_amount|HUMANA COMMERCIAL POS|MEDICARE,standard_charge|HUMANA COMMERCIAL POS|MEDICARE|methodology,additional_payer_notes|HUMANA COMMERCIAL POS|MEDICARE,standard_charge|HUMANA COMMERCIAL PPO|MEDICARE|negotiated_dollar,standard_charge|HUMANA COMMERCIAL PPO|MEDICARE|negotiated_percentage,standard_charge|HUMANA COMMERCIAL PPO|MEDICARE|negotiated_algorithm,estimated_amount|HUMANA COMMERCIAL PPO|MEDICARE,standard_charge|HUMANA COMMERCIAL PPO|MEDICARE|methodology,additional_payer_notes|HUMANA COMMERCIAL PPO|MEDICARE,standard_charge|HUMANA COMMERCIAL PPOX|MEDICARE|negotiated_dollar,standard_charge|HUMANA COMMERCIAL PPOX|MEDICARE|negotiated_percentage,standard_charge|HUMANA COMMERCIAL PPOX|MEDICARE|negotiated_algorithm,estimated_amount|HUMANA COMMERCIAL PPOX|MEDICARE,standard_charge|HUMANA COMMERCIAL PPOX|MEDICARE|methodology,additional_payer_notes|HUMANA COMMERCIAL PPOX|MEDICARE,standard_charge|HUMANA MEDICAID|MEDICAID|negotiated_dollar,standard_charge|HUMANA MEDICAID|MEDICAID|negotiated_percentage,standard_charge|HUMANA MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|HUMANA MEDICAID|MEDICAID,standard_charge|HUMANA MEDICAID|MEDICAID|methodology,additional_payer_notes|HUMANA MEDICAID|MEDICAID,standard_charge|UHC|COMMERCIAL|negotiated_dollar,standard_charge|UHC|COMMERCIAL|negotiated_percentage,standard_charge|UHC|COMMERCIAL|negotiated_algorithm,estimated_amount|UHC|COMMERCIAL,standard_charge|UHC|COMMERCIAL|methodology,additional_payer_notes|UHC|COMMERCIAL,standard_charge|UHC MEDICAID|MEDICAID|negotiated_dollar,standard_charge|UHC MEDICAID|MEDICAID|negotiated_percentage,standard_charge|UHC MEDICAID|MEDICAID|negotiated_algorithm,estimated_amount|UHC MEDICAID|MEDICAID,standard_charge|UHC MEDICAID|MEDICAID|methodology,additional_payer_notes|UHC MEDICAID|MEDICAID,standard_charge|min,standard_charge|max,additional_generic_notes
ACETAMINOPHEN,7000029,CDM,301,RC,80143,HCPCS,Outpatient,,,411.78,329.42,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,329.42,80,,263.54,percent of total billed charges,80% of total billed charges,153.47,37.27,,122.78,percent of total billed charges,37.27% of total billed charges,153.47,37.27,,122.78,percent of total billed charges,37.27% of total billed charges,153.47,37.27,,122.78,percent of total billed charges,37.27% of total billed charges,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.71,40,,131.77,percent of total billed charges,40% of total billed charges,13.98,329.42,
ADRENOCORTICOTROPIC,7000029,CDM,301,RC,82024,HCPCS,Outpatient,,,217,173.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,80.88,37.27,,64.7,percent of total billed charges,37.27% of total billed charges,80.88,37.27,,64.7,percent of total billed charges,37.27% of total billed charges,80.88,37.27,,64.7,percent of total billed charges,37.27% of total billed charges,28.97,75,,,fee schedule,75% of CMS fee schedule,28.97,75,,,fee schedule,75% of CMS fee schedule,38.62,100,,,fee schedule,100% of CMS fee schedule,38.62,100,,,fee schedule,100% of CMS fee schedule,28.97,75,,,fee schedule,75% of CMS fee schedule,28.97,75,,,fee schedule,75% of CMS fee schedule,38.62,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.8,40,,69.44,percent of total billed charges,40% of total billed charges,28.97,173.6,
"ALDOLASE, SERUM",7000029,CDM,301,RC,82085,HCPCS,Outpatient,,,192,153.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,71.56,37.27,,57.25,percent of total billed charges,37.27% of total billed charges,71.56,37.27,,57.25,percent of total billed charges,37.27% of total billed charges,71.56,37.27,,57.25,percent of total billed charges,37.27% of total billed charges,7.28,75,,,fee schedule,75% of CMS fee schedule,7.28,75,,,fee schedule,75% of CMS fee schedule,9.71,100,,,fee schedule,100% of CMS fee schedule,9.71,100,,,fee schedule,100% of CMS fee schedule,7.28,75,,,fee schedule,75% of CMS fee schedule,7.28,75,,,fee schedule,75% of CMS fee schedule,9.71,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,40,,61.44,percent of total billed charges,40% of total billed charges,7.28,153.6,
ALDOSTERONE,7000029,CDM,301,RC,82088,HCPCS,Outpatient,,,228,182.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,182.4,80,,145.92,percent of total billed charges,80% of total billed charges,84.98,37.27,,67.98,percent of total billed charges,37.27% of total billed charges,84.98,37.27,,67.98,percent of total billed charges,37.27% of total billed charges,84.98,37.27,,67.98,percent of total billed charges,37.27% of total billed charges,30.56,75,,,fee schedule,75% of CMS fee schedule,30.56,75,,,fee schedule,75% of CMS fee schedule,40.75,100,,,fee schedule,100% of CMS fee schedule,40.75,100,,,fee schedule,100% of CMS fee schedule,30.56,75,,,fee schedule,75% of CMS fee schedule,30.56,75,,,fee schedule,75% of CMS fee schedule,40.75,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,40,,72.96,percent of total billed charges,40% of total billed charges,30.56,182.4,
ALKALINE PHOSP ISOEZ,7000029,CDM,301,RC,84080,HCPCS,Outpatient,,,91,72.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,11.09,75,,,fee schedule,75% of CMS fee schedule,11.09,75,,,fee schedule,75% of CMS fee schedule,14.78,100,,,fee schedule,100% of CMS fee schedule,14.78,100,,,fee schedule,100% of CMS fee schedule,11.09,75,,,fee schedule,75% of CMS fee schedule,11.09,75,,,fee schedule,75% of CMS fee schedule,14.78,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.4,40,,29.12,percent of total billed charges,40% of total billed charges,11.09,72.8,
AMITRIPTYLINE (ELAVI,7000029,CDM,301,RC,80299,HCPCS,Outpatient,,,140,112.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112,80,,89.6,percent of total billed charges,80% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,40,,44.8,percent of total billed charges,40% of total billed charges,13.98,112,
DGP ANTIBODY,7000169,CDM,302,RC,86258,HCPCS,Outpatient,,,70.7,56.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.56,80,,45.25,percent of total billed charges,80% of total billed charges,26.35,37.27,,21.08,percent of total billed charges,37.27% of total billed charges,26.35,37.27,,21.08,percent of total billed charges,37.27% of total billed charges,26.35,37.27,,21.08,percent of total billed charges,37.27% of total billed charges,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.28,40,,22.62,percent of total billed charges,40% of total billed charges,9.04,56.56,
"ANTI-THROMBIN III, F",7000177,CDM,305,RC,85300,HCPCS,Outpatient,,,241,192.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,89.82,37.27,,71.86,percent of total billed charges,37.27% of total billed charges,89.82,37.27,,71.86,percent of total billed charges,37.27% of total billed charges,89.82,37.27,,71.86,percent of total billed charges,37.27% of total billed charges,8.89,75,,,fee schedule,75% of CMS fee schedule,8.89,75,,,fee schedule,75% of CMS fee schedule,11.85,100,,,fee schedule,100% of CMS fee schedule,11.85,100,,,fee schedule,100% of CMS fee schedule,8.89,75,,,fee schedule,75% of CMS fee schedule,8.89,75,,,fee schedule,75% of CMS fee schedule,11.85,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.4,40,,77.12,percent of total billed charges,40% of total billed charges,8.89,192.8,
ANTITHYROGLOBULIN AB,7000169,CDM,302,RC,86800,HCPCS,Outpatient,,,88,70.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,11.93,75,,,fee schedule,75% of CMS fee schedule,11.93,75,,,fee schedule,75% of CMS fee schedule,15.91,100,,,fee schedule,100% of CMS fee schedule,15.91,100,,,fee schedule,100% of CMS fee schedule,11.93,75,,,fee schedule,75% of CMS fee schedule,11.93,75,,,fee schedule,75% of CMS fee schedule,15.91,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,40,,28.16,percent of total billed charges,40% of total billed charges,11.93,70.4,
CARBAMAZEPINE,7000029,CDM,301,RC,80156,HCPCS,Outpatient,,,104,83.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,38.76,37.27,,31.01,percent of total billed charges,37.27% of total billed charges,38.76,37.27,,31.01,percent of total billed charges,37.27% of total billed charges,38.76,37.27,,31.01,percent of total billed charges,37.27% of total billed charges,10.93,75,,,fee schedule,75% of CMS fee schedule,10.93,75,,,fee schedule,75% of CMS fee schedule,14.57,100,,,fee schedule,100% of CMS fee schedule,14.57,100,,,fee schedule,100% of CMS fee schedule,10.93,75,,,fee schedule,75% of CMS fee schedule,10.93,75,,,fee schedule,75% of CMS fee schedule,14.57,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,40,,33.28,percent of total billed charges,40% of total billed charges,10.93,83.2,
"CHROMOSOME ANALYSIS,",7000268,CDM,310,RC,88230,HCPCS,Outpatient,,,304.71,243.77,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.77,80,,195.02,percent of total billed charges,80% of total billed charges,113.57,37.27,,90.86,percent of total billed charges,37.27% of total billed charges,113.57,37.27,,90.86,percent of total billed charges,37.27% of total billed charges,113.57,37.27,,90.86,percent of total billed charges,37.27% of total billed charges,87.37,75,,,fee schedule,75% of CMS fee schedule,87.37,75,,,fee schedule,75% of CMS fee schedule,116.49,100,,,fee schedule,100% of CMS fee schedule,116.49,100,,,fee schedule,100% of CMS fee schedule,87.37,75,,,fee schedule,75% of CMS fee schedule,87.37,75,,,fee schedule,75% of CMS fee schedule,116.49,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.88,40,,97.5,percent of total billed charges,40% of total billed charges,87.37,243.77,
"CHLAMYDIA DNA,PCR,UR",7000284,CDM,306,RC,87491,HCPCS,Outpatient,,,83,66.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.2,40,,26.56,percent of total billed charges,40% of total billed charges,26.32,66.4,
COMPLEMENT 50 TOTAL,7000169,CDM,302,RC,86162,HCPCS,Outpatient,,,108,86.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,15.24,75,,,fee schedule,75% of CMS fee schedule,15.24,75,,,fee schedule,75% of CMS fee schedule,20.32,100,,,fee schedule,100% of CMS fee schedule,20.32,100,,,fee schedule,100% of CMS fee schedule,15.24,75,,,fee schedule,75% of CMS fee schedule,15.24,75,,,fee schedule,75% of CMS fee schedule,20.32,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,15.24,86.4,
COMPLEMENT  C3,7000169,CDM,302,RC,86160,HCPCS,Outpatient,,,67,53.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,9,75,,,fee schedule,75% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,9,53.6,
"COMPLEMENT, C5",7000169,CDM,302,RC,86160,HCPCS,Outpatient,,,88,70.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,9,75,,,fee schedule,75% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,40,,28.16,percent of total billed charges,40% of total billed charges,9,70.4,
CORTISOL LEVEL,7000029,CDM,301,RC,82533,HCPCS,Outpatient,,,91,72.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,12.23,75,,,fee schedule,75% of CMS fee schedule,12.23,75,,,fee schedule,75% of CMS fee schedule,16.3,100,,,fee schedule,100% of CMS fee schedule,16.3,100,,,fee schedule,100% of CMS fee schedule,12.23,75,,,fee schedule,75% of CMS fee schedule,12.23,75,,,fee schedule,75% of CMS fee schedule,16.3,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.4,40,,29.12,percent of total billed charges,40% of total billed charges,12.23,72.8,
CMV-G,7000169,CDM,302,RC,86644,HCPCS,Outpatient,,,80,64.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,10.79,75,,,fee schedule,75% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,40,,25.6,percent of total billed charges,40% of total billed charges,10.79,64,
CMV-M,7000169,CDM,302,RC,86645,HCPCS,Outpatient,,,94,75.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,12.64,75,,,fee schedule,75% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,12.64,75.2,
ESTRADIOL (E-2),7000029,CDM,301,RC,82670,HCPCS,Outpatient,,,157,125.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,58.51,37.27,,46.81,percent of total billed charges,37.27% of total billed charges,58.51,37.27,,46.81,percent of total billed charges,37.27% of total billed charges,58.51,37.27,,46.81,percent of total billed charges,37.27% of total billed charges,20.96,75,,,fee schedule,75% of CMS fee schedule,20.96,75,,,fee schedule,75% of CMS fee schedule,27.94,100,,,fee schedule,100% of CMS fee schedule,27.94,100,,,fee schedule,100% of CMS fee schedule,20.96,75,,,fee schedule,75% of CMS fee schedule,20.96,75,,,fee schedule,75% of CMS fee schedule,27.94,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.8,40,,50.24,percent of total billed charges,40% of total billed charges,20.96,125.6,
ESTRONE (E1),7000029,CDM,301,RC,82679,HCPCS,Outpatient,,,140,112.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112,80,,89.6,percent of total billed charges,80% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,18.71,75,,,fee schedule,75% of CMS fee schedule,18.71,75,,,fee schedule,75% of CMS fee schedule,24.95,100,,,fee schedule,100% of CMS fee schedule,24.95,100,,,fee schedule,100% of CMS fee schedule,18.71,75,,,fee schedule,75% of CMS fee schedule,18.71,75,,,fee schedule,75% of CMS fee schedule,24.95,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,40,,44.8,percent of total billed charges,40% of total billed charges,18.71,112,
FERRITIN,7000029,CDM,301,RC,82728,HCPCS,Outpatient,,,76,60.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,10.22,75,,,fee schedule,75% of CMS fee schedule,10.22,75,,,fee schedule,75% of CMS fee schedule,13.63,100,,,fee schedule,100% of CMS fee schedule,13.63,100,,,fee schedule,100% of CMS fee schedule,10.22,75,,,fee schedule,75% of CMS fee schedule,10.22,75,,,fee schedule,75% of CMS fee schedule,13.63,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,40,,24.32,percent of total billed charges,40% of total billed charges,10.22,60.8,
FSH,7000029,CDM,301,RC,83001,HCPCS,Outpatient,,,120,96.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,13.94,75,,,fee schedule,75% of CMS fee schedule,13.94,75,,,fee schedule,75% of CMS fee schedule,18.58,100,,,fee schedule,100% of CMS fee schedule,18.58,100,,,fee schedule,100% of CMS fee schedule,13.94,75,,,fee schedule,75% of CMS fee schedule,13.94,75,,,fee schedule,75% of CMS fee schedule,18.58,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,40,,38.4,percent of total billed charges,40% of total billed charges,13.94,96,
"T4,FREE",7000029,CDM,301,RC,84439,HCPCS,Outpatient,,,56,44.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,6.77,75,,,fee schedule,75% of CMS fee schedule,6.77,75,,,fee schedule,75% of CMS fee schedule,9.02,100,,,fee schedule,100% of CMS fee schedule,9.02,100,,,fee schedule,100% of CMS fee schedule,6.77,75,,,fee schedule,75% of CMS fee schedule,6.77,75,,,fee schedule,75% of CMS fee schedule,9.02,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,40,,17.92,percent of total billed charges,40% of total billed charges,6.77,44.8,
FUNGAL ANTIBODIES,7000169,CDM,302,RC,86606,HCPCS,Outpatient,,,84,67.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,31.31,37.27,,25.05,percent of total billed charges,37.27% of total billed charges,31.31,37.27,,25.05,percent of total billed charges,37.27% of total billed charges,31.31,37.27,,25.05,percent of total billed charges,37.27% of total billed charges,11.29,75,,,fee schedule,75% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,40,,26.88,percent of total billed charges,40% of total billed charges,11.29,67.2,
GASTRIN,7000029,CDM,301,RC,82941,HCPCS,Outpatient,,,98,78.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.4,80,,62.72,percent of total billed charges,80% of total billed charges,36.52,37.27,,29.22,percent of total billed charges,37.27% of total billed charges,36.52,37.27,,29.22,percent of total billed charges,37.27% of total billed charges,36.52,37.27,,29.22,percent of total billed charges,37.27% of total billed charges,13.22,75,,,fee schedule,75% of CMS fee schedule,13.22,75,,,fee schedule,75% of CMS fee schedule,17.63,100,,,fee schedule,100% of CMS fee schedule,17.63,100,,,fee schedule,100% of CMS fee schedule,13.22,75,,,fee schedule,75% of CMS fee schedule,13.22,75,,,fee schedule,75% of CMS fee schedule,17.63,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,40,,31.36,percent of total billed charges,40% of total billed charges,13.22,78.4,
GGTP,7000029,CDM,301,RC,82977,HCPCS,Outpatient,,,41,32.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,5.4,75,,,fee schedule,75% of CMS fee schedule,5.4,75,,,fee schedule,75% of CMS fee schedule,7.2,100,,,fee schedule,100% of CMS fee schedule,7.2,100,,,fee schedule,100% of CMS fee schedule,5.4,75,,,fee schedule,75% of CMS fee schedule,5.4,75,,,fee schedule,75% of CMS fee schedule,7.2,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,5.4,32.8,
HEMOGLOBIN A1C,7000029,CDM,301,RC,83036,HCPCS,Outpatient,,,55,44.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,7.28,75,,,fee schedule,75% of CMS fee schedule,7.28,75,,,fee schedule,75% of CMS fee schedule,9.71,100,,,fee schedule,100% of CMS fee schedule,9.71,100,,,fee schedule,100% of CMS fee schedule,7.28,75,,,fee schedule,75% of CMS fee schedule,7.28,75,,,fee schedule,75% of CMS fee schedule,9.71,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22,40,,17.6,percent of total billed charges,40% of total billed charges,7.28,44,
GROWTH HORMONE,7000029,CDM,301,RC,83003,HCPCS,Outpatient,,,92,73.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,12.5,75,,,fee schedule,75% of CMS fee schedule,12.5,75,,,fee schedule,75% of CMS fee schedule,16.67,100,,,fee schedule,100% of CMS fee schedule,16.67,100,,,fee schedule,100% of CMS fee schedule,12.5,75,,,fee schedule,75% of CMS fee schedule,12.5,75,,,fee schedule,75% of CMS fee schedule,16.67,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,40,,29.44,percent of total billed charges,40% of total billed charges,12.5,73.6,
HAPTOGLOBIN SERUM,7000029,CDM,301,RC,83010,HCPCS,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,9.44,75,,,fee schedule,75% of CMS fee schedule,9.44,75,,,fee schedule,75% of CMS fee schedule,12.58,100,,,fee schedule,100% of CMS fee schedule,12.58,100,,,fee schedule,100% of CMS fee schedule,9.44,75,,,fee schedule,75% of CMS fee schedule,9.44,75,,,fee schedule,75% of CMS fee schedule,12.58,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28,40,,22.4,percent of total billed charges,40% of total billed charges,9.44,56,
HEP B SURF ANTIG OB,7000284,CDM,306,RC,87340,HCPCS,Outpatient,,,59,47.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,7.75,75,,,fee schedule,75% of CMS fee schedule,7.75,75,,,fee schedule,75% of CMS fee schedule,10.33,100,,,fee schedule,100% of CMS fee schedule,10.33,100,,,fee schedule,100% of CMS fee schedule,7.75,75,,,fee schedule,75% of CMS fee schedule,7.75,75,,,fee schedule,75% of CMS fee schedule,10.33,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.6,40,,18.88,percent of total billed charges,40% of total billed charges,7.75,47.2,
"INFLUENZA A OR B, EA",7000284,CDM,306,RC,87400,HCPCS,Outpatient,,,56.47,45.18,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.18,80,,36.14,percent of total billed charges,80% of total billed charges,21.05,37.27,,16.84,percent of total billed charges,37.27% of total billed charges,21.05,37.27,,16.84,percent of total billed charges,37.27% of total billed charges,21.05,37.27,,16.84,percent of total billed charges,37.27% of total billed charges,10.6,75,,,fee schedule,75% of CMS fee schedule,10.6,75,,,fee schedule,75% of CMS fee schedule,14.13,100,,,fee schedule,100% of CMS fee schedule,14.13,100,,,fee schedule,100% of CMS fee schedule,10.6,75,,,fee schedule,75% of CMS fee schedule,10.6,75,,,fee schedule,75% of CMS fee schedule,14.13,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.59,40,,18.07,percent of total billed charges,40% of total billed charges,10.6,45.18,
ACUTE HEPATITIS PANE,7000029,CDM,301,RC,80074,HCPCS,Outpatient,,,267,213.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,213.6,80,,170.88,percent of total billed charges,80% of total billed charges,99.51,37.27,,79.61,percent of total billed charges,37.27% of total billed charges,99.51,37.27,,79.61,percent of total billed charges,37.27% of total billed charges,99.51,37.27,,79.61,percent of total billed charges,37.27% of total billed charges,35.72,75,,,fee schedule,75% of CMS fee schedule,35.72,75,,,fee schedule,75% of CMS fee schedule,47.63,100,,,fee schedule,100% of CMS fee schedule,47.63,100,,,fee schedule,100% of CMS fee schedule,35.72,75,,,fee schedule,75% of CMS fee schedule,35.72,75,,,fee schedule,75% of CMS fee schedule,47.63,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.8,40,,85.44,percent of total billed charges,40% of total billed charges,35.72,213.6,
"LEGIONELLA ANTIBODY,",7000169,CDM,302,RC,86713,HCPCS,Outpatient,,,332,265.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,265.6,80,,212.48,percent of total billed charges,80% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% of total billed charges,11.48,75,,,fee schedule,75% of CMS fee schedule,11.48,75,,,fee schedule,75% of CMS fee schedule,15.3,100,,,fee schedule,100% of CMS fee schedule,15.3,100,,,fee schedule,100% of CMS fee schedule,11.48,75,,,fee schedule,75% of CMS fee schedule,11.48,75,,,fee schedule,75% of CMS fee schedule,15.3,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.8,40,,106.24,percent of total billed charges,40% of total billed charges,11.48,265.6,
LEGIONELLA ANTIGEN U,7000284,CDM,306,RC,87449,HCPCS,Outpatient,,,140,112.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112,80,,89.6,percent of total billed charges,80% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,8.99,75,,,fee schedule,75% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,40,,44.8,percent of total billed charges,40% of total billed charges,8.99,112,
NUCLEOTIDASE,7000029,CDM,301,RC,83915,HCPCS,Outpatient,,,80,64.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,8.36,75,,,fee schedule,75% of CMS fee schedule,8.36,75,,,fee schedule,75% of CMS fee schedule,11.15,100,,,fee schedule,100% of CMS fee schedule,11.15,100,,,fee schedule,100% of CMS fee schedule,8.36,75,,,fee schedule,75% of CMS fee schedule,8.36,75,,,fee schedule,75% of CMS fee schedule,11.15,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,40,,25.6,percent of total billed charges,40% of total billed charges,8.36,64,
PROCAINAMIDE& METABO,7000029,CDM,301,RC,80192,HCPCS,Outpatient,,,94,75.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,12.56,75,,,fee schedule,75% of CMS fee schedule,12.56,75,,,fee schedule,75% of CMS fee schedule,16.75,100,,,fee schedule,100% of CMS fee schedule,16.75,100,,,fee schedule,100% of CMS fee schedule,12.56,75,,,fee schedule,75% of CMS fee schedule,12.56,75,,,fee schedule,75% of CMS fee schedule,16.75,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,12.56,75.2,
PROGESTERONE,7000029,CDM,301,RC,84144,HCPCS,Outpatient,,,118,94.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,15.65,75,,,fee schedule,75% of CMS fee schedule,15.65,75,,,fee schedule,75% of CMS fee schedule,20.86,100,,,fee schedule,100% of CMS fee schedule,20.86,100,,,fee schedule,100% of CMS fee schedule,15.65,75,,,fee schedule,75% of CMS fee schedule,15.65,75,,,fee schedule,75% of CMS fee schedule,20.86,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,40,,37.76,percent of total billed charges,40% of total billed charges,15.65,94.4,
PROSTATIC ACID PHOS,7000029,CDM,301,RC,84066,HCPCS,Outpatient,,,56,44.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,7.25,75,,,fee schedule,75% of CMS fee schedule,7.25,75,,,fee schedule,75% of CMS fee schedule,9.66,100,,,fee schedule,100% of CMS fee schedule,9.66,100,,,fee schedule,100% of CMS fee schedule,7.25,75,,,fee schedule,75% of CMS fee schedule,7.25,75,,,fee schedule,75% of CMS fee schedule,9.66,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,40,,17.92,percent of total billed charges,40% of total billed charges,7.25,44.8,
QUINIDINE,7000029,CDM,301,RC,80194,HCPCS,Outpatient,,,81,64.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,10.95,75,,,fee schedule,75% of CMS fee schedule,10.95,75,,,fee schedule,75% of CMS fee schedule,14.6,100,,,fee schedule,100% of CMS fee schedule,14.6,100,,,fee schedule,100% of CMS fee schedule,10.95,75,,,fee schedule,75% of CMS fee schedule,10.95,75,,,fee schedule,75% of CMS fee schedule,14.6,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,40,,25.92,percent of total billed charges,40% of total billed charges,10.95,64.8,
SOMATOMEDIN,7000029,CDM,301,RC,84305,HCPCS,Outpatient,,,93.63,74.90,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.9,80,,59.92,percent of total billed charges,80% of total billed charges,34.9,37.27,,27.92,percent of total billed charges,37.27% of total billed charges,34.9,37.27,,27.92,percent of total billed charges,37.27% of total billed charges,34.9,37.27,,27.92,percent of total billed charges,37.27% of total billed charges,15.95,75,,,fee schedule,75% of CMS fee schedule,15.95,75,,,fee schedule,75% of CMS fee schedule,21.26,100,,,fee schedule,100% of CMS fee schedule,21.26,100,,,fee schedule,100% of CMS fee schedule,15.95,75,,,fee schedule,75% of CMS fee schedule,15.95,75,,,fee schedule,75% of CMS fee schedule,21.26,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.45,40,,29.96,percent of total billed charges,40% of total billed charges,15.95,74.9,
FOLATES RED CELL,7000029,CDM,301,RC,82747,HCPCS,Outpatient,,,111,88.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% of total billed charges,13.24,75,,,fee schedule,75% of CMS fee schedule,13.24,75,,,fee schedule,75% of CMS fee schedule,17.65,100,,,fee schedule,100% of CMS fee schedule,17.65,100,,,fee schedule,100% of CMS fee schedule,13.24,75,,,fee schedule,75% of CMS fee schedule,13.24,75,,,fee schedule,75% of CMS fee schedule,17.65,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,40,,35.52,percent of total billed charges,40% of total billed charges,13.24,88.8,
SJOGREN ANTIBODY,7000169,CDM,302,RC,86235,HCPCS,Outpatient,,,161,128.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.4,40,,51.52,percent of total billed charges,40% of total billed charges,13.45,128.8,
T4,7000029,CDM,301,RC,84436,HCPCS,Outpatient,,,55,44.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,5.15,75,,,fee schedule,75% of CMS fee schedule,5.15,75,,,fee schedule,75% of CMS fee schedule,6.87,100,,,fee schedule,100% of CMS fee schedule,6.87,100,,,fee schedule,100% of CMS fee schedule,5.15,75,,,fee schedule,75% of CMS fee schedule,5.15,75,,,fee schedule,75% of CMS fee schedule,6.87,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22,40,,17.6,percent of total billed charges,40% of total billed charges,5.15,44,
HEPATITIS BE ANTIGEN,7000284,CDM,306,RC,87350,HCPCS,Outpatient,,,64,51.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,8.65,51.2,
VALPROIC ACID,7000029,CDM,301,RC,80164,HCPCS,Outpatient,,,76,60.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,10.16,75,,,fee schedule,75% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,40,,24.32,percent of total billed charges,40% of total billed charges,10.16,60.8,
"COMPLEMENT, C4",7000169,CDM,302,RC,86160,HCPCS,Outpatient,,,67,53.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,9,75,,,fee schedule,75% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,9,53.6,
LEUKOCYTE ALKALINE,7000177,CDM,305,RC,85540,HCPCS,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,6.45,75,,,fee schedule,75% of CMS fee schedule,6.45,75,,,fee schedule,75% of CMS fee schedule,8.6,100,,,fee schedule,100% of CMS fee schedule,8.6,100,,,fee schedule,100% of CMS fee schedule,6.45,75,,,fee schedule,75% of CMS fee schedule,6.45,75,,,fee schedule,75% of CMS fee schedule,8.6,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,40,,16,percent of total billed charges,40% of total billed charges,6.45,40,
TOBRAMYCIN PEAK,7000029,CDM,301,RC,80200,HCPCS,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,12.1,75,,,fee schedule,75% of CMS fee schedule,12.1,75,,,fee schedule,75% of CMS fee schedule,16.13,100,,,fee schedule,100% of CMS fee schedule,16.13,100,,,fee schedule,100% of CMS fee schedule,12.1,75,,,fee schedule,75% of CMS fee schedule,12.1,75,,,fee schedule,75% of CMS fee schedule,16.13,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,12.1,59.2,
NATURAL KILLER CELL,7000169,CDM,302,RC,86357,HCPCS,Outpatient,,,154,123.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,57.4,37.27,,45.92,percent of total billed charges,37.27% of total billed charges,57.4,37.27,,45.92,percent of total billed charges,37.27% of total billed charges,57.4,37.27,,45.92,percent of total billed charges,37.27% of total billed charges,28.3,75,,,fee schedule,75% of CMS fee schedule,28.3,75,,,fee schedule,75% of CMS fee schedule,37.73,100,,,fee schedule,100% of CMS fee schedule,37.73,100,,,fee schedule,100% of CMS fee schedule,28.3,75,,,fee schedule,75% of CMS fee schedule,28.3,75,,,fee schedule,75% of CMS fee schedule,37.73,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,40,,49.28,percent of total billed charges,40% of total billed charges,28.3,123.2,
SGOT,7000029,CDM,301,RC,84450,HCPCS,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,3.89,75,,,fee schedule,75% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,3.89,22.4,
GRAM STAIN,7000284,CDM,306,RC,87205,HCPCS,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,3.2,19.2,
"CALPROTECTIN, FECAL",7000029,CDM,301,RC,83993,HCPCS,Outpatient,,,223,178.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178.4,80,,142.72,percent of total billed charges,80% of total billed charges,83.11,37.27,,66.49,percent of total billed charges,37.27% of total billed charges,83.11,37.27,,66.49,percent of total billed charges,37.27% of total billed charges,83.11,37.27,,66.49,percent of total billed charges,37.27% of total billed charges,14.72,75,,,fee schedule,75% of CMS fee schedule,14.72,75,,,fee schedule,75% of CMS fee schedule,19.63,100,,,fee schedule,100% of CMS fee schedule,19.63,100,,,fee schedule,100% of CMS fee schedule,14.72,75,,,fee schedule,75% of CMS fee schedule,14.72,75,,,fee schedule,75% of CMS fee schedule,19.63,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.2,40,,71.36,percent of total billed charges,40% of total billed charges,14.72,178.4,
ALBUMIN URINE/OTHER,7000029,CDM,301,RC,82042,HCPCS,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,5.84,75,,,fee schedule,75% of CMS fee schedule,5.84,75,,,fee schedule,75% of CMS fee schedule,7.78,100,,,fee schedule,100% of CMS fee schedule,7.78,100,,,fee schedule,100% of CMS fee schedule,5.84,75,,,fee schedule,75% of CMS fee schedule,5.84,75,,,fee schedule,75% of CMS fee schedule,7.78,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,5.84,22.4,
CBC,7000177,CDM,305,RC,85025,HCPCS,Outpatient,,,108,86.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,5.83,75,,,fee schedule,75% of CMS fee schedule,5.83,75,,,fee schedule,75% of CMS fee schedule,7.77,100,,,fee schedule,100% of CMS fee schedule,7.77,100,,,fee schedule,100% of CMS fee schedule,5.83,75,,,fee schedule,75% of CMS fee schedule,5.83,75,,,fee schedule,75% of CMS fee schedule,7.77,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,5.83,86.4,
THYROID BINDING GLOB,7000029,CDM,301,RC,84442,HCPCS,Outpatient,,,101,80.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,11.09,75,,,fee schedule,75% of CMS fee schedule,11.09,75,,,fee schedule,75% of CMS fee schedule,14.78,100,,,fee schedule,100% of CMS fee schedule,14.78,100,,,fee schedule,100% of CMS fee schedule,11.09,75,,,fee schedule,75% of CMS fee schedule,11.09,75,,,fee schedule,75% of CMS fee schedule,14.78,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.4,40,,32.32,percent of total billed charges,40% of total billed charges,11.09,80.8,
INHIBIN A,7000169,CDM,302,RC,86336,HCPCS,Outpatient,,,276,220.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.8,80,,176.64,percent of total billed charges,80% of total billed charges,102.87,37.27,,82.3,percent of total billed charges,37.27% of total billed charges,102.87,37.27,,82.3,percent of total billed charges,37.27% of total billed charges,102.87,37.27,,82.3,percent of total billed charges,37.27% of total billed charges,11.69,75,,,fee schedule,75% of CMS fee schedule,11.69,75,,,fee schedule,75% of CMS fee schedule,15.59,100,,,fee schedule,100% of CMS fee schedule,15.59,100,,,fee schedule,100% of CMS fee schedule,11.69,75,,,fee schedule,75% of CMS fee schedule,11.69,75,,,fee schedule,75% of CMS fee schedule,15.59,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.4,40,,88.32,percent of total billed charges,40% of total billed charges,11.69,220.8,
CRYPTOCOCCUS ANTIBOD,7000169,CDM,302,RC,86641,HCPCS,Outpatient,,,140,112.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112,80,,89.6,percent of total billed charges,80% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,10.81,75,,,fee schedule,75% of CMS fee schedule,10.81,75,,,fee schedule,75% of CMS fee schedule,14.41,100,,,fee schedule,100% of CMS fee schedule,14.41,100,,,fee schedule,100% of CMS fee schedule,10.81,75,,,fee schedule,75% of CMS fee schedule,10.81,75,,,fee schedule,75% of CMS fee schedule,14.41,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,40,,44.8,percent of total billed charges,40% of total billed charges,10.81,112,
"STRONGYLOIDES, SERUM",7000169,CDM,302,RC,86682,HCPCS,Outpatient,,,126,100.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,9.76,75,,,fee schedule,75% of CMS fee schedule,9.76,75,,,fee schedule,75% of CMS fee schedule,13.01,100,,,fee schedule,100% of CMS fee schedule,13.01,100,,,fee schedule,100% of CMS fee schedule,9.76,75,,,fee schedule,75% of CMS fee schedule,9.76,75,,,fee schedule,75% of CMS fee schedule,13.01,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,40,,40.32,percent of total billed charges,40% of total billed charges,9.76,100.8,
ZONISAMIDE (ZONEGRAN,7000029,CDM,301,RC,80203,HCPCS,Outpatient,,,176,140.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% of total billed charges,9.94,75,,,fee schedule,75% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,40,,56.32,percent of total billed charges,40% of total billed charges,9.94,140.8,
GTT 1 HR,7000029,CDM,301,RC,82950,HCPCS,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,3.56,75,,,fee schedule,75% of CMS fee schedule,3.56,75,,,fee schedule,75% of CMS fee schedule,4.75,100,,,fee schedule,100% of CMS fee schedule,4.75,100,,,fee schedule,100% of CMS fee schedule,3.56,75,,,fee schedule,75% of CMS fee schedule,3.56,75,,,fee schedule,75% of CMS fee schedule,4.75,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,3.56,21.6,
"CREATININE, 24HR URN",7000029,CDM,301,RC,82570,HCPCS,Outpatient,,,36,28.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,3.89,75,,,fee schedule,75% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,3.89,28.8,
RMSF IGM,7000169,CDM,302,RC,86255,HCPCS,Outpatient,,,90,72.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,40,,28.8,percent of total billed charges,40% of total billed charges,9.04,72,
LYME (B. BURGDORFERI,7000169,CDM,302,RC,86618,HCPCS,Outpatient,,,95,76.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,12.77,75,,,fee schedule,75% of CMS fee schedule,12.77,75,,,fee schedule,75% of CMS fee schedule,17.03,100,,,fee schedule,100% of CMS fee schedule,17.03,100,,,fee schedule,100% of CMS fee schedule,12.77,75,,,fee schedule,75% of CMS fee schedule,12.77,75,,,fee schedule,75% of CMS fee schedule,17.03,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38,40,,30.4,percent of total billed charges,40% of total billed charges,12.77,76,
SOTALOL (BETAPACE) L,7000029,CDM,301,RC,82542,HCPCS,Outpatient,,,165,132.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,18.07,75,,,fee schedule,75% of CMS fee schedule,18.07,75,,,fee schedule,75% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,18.07,75,,,fee schedule,75% of CMS fee schedule,18.07,75,,,fee schedule,75% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,40,,52.8,percent of total billed charges,40% of total billed charges,18.07,132,
"EBV VCA AB, IGM",7000169,CDM,302,RC,86665,HCPCS,Outpatient,,,99,79.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,13.61,75,,,fee schedule,75% of CMS fee schedule,13.61,75,,,fee schedule,75% of CMS fee schedule,18.14,100,,,fee schedule,100% of CMS fee schedule,18.14,100,,,fee schedule,100% of CMS fee schedule,13.61,75,,,fee schedule,75% of CMS fee schedule,13.61,75,,,fee schedule,75% of CMS fee schedule,18.14,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,13.61,79.2,
"EBV VCA AB, IGG",7000169,CDM,302,RC,86665,HCPCS,Outpatient,,,99,79.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,13.61,75,,,fee schedule,75% of CMS fee schedule,13.61,75,,,fee schedule,75% of CMS fee schedule,18.14,100,,,fee schedule,100% of CMS fee schedule,18.14,100,,,fee schedule,100% of CMS fee schedule,13.61,75,,,fee schedule,75% of CMS fee schedule,13.61,75,,,fee schedule,75% of CMS fee schedule,18.14,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,13.61,79.2,
EBV NUCLEAR ANTIGEN,7000169,CDM,302,RC,86664,HCPCS,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,11.47,75,,,fee schedule,75% of CMS fee schedule,11.47,75,,,fee schedule,75% of CMS fee schedule,15.29,100,,,fee schedule,100% of CMS fee schedule,15.29,100,,,fee schedule,100% of CMS fee schedule,11.47,75,,,fee schedule,75% of CMS fee schedule,11.47,75,,,fee schedule,75% of CMS fee schedule,15.29,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34,40,,27.2,percent of total billed charges,40% of total billed charges,11.47,68,
VITAMIN B2,7000029,CDM,301,RC,84252,HCPCS,Outpatient,,,165,132.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,15.18,75,,,fee schedule,75% of CMS fee schedule,15.18,75,,,fee schedule,75% of CMS fee schedule,20.24,100,,,fee schedule,100% of CMS fee schedule,20.24,100,,,fee schedule,100% of CMS fee schedule,15.18,75,,,fee schedule,75% of CMS fee schedule,15.18,75,,,fee schedule,75% of CMS fee schedule,20.24,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,40,,52.8,percent of total billed charges,40% of total billed charges,15.18,132,
"MAGNESIUM, RBC",7000029,CDM,301,RC,83735,HCPCS,Outpatient,,,91,72.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,5.03,75,,,fee schedule,75% of CMS fee schedule,5.03,75,,,fee schedule,75% of CMS fee schedule,6.7,100,,,fee schedule,100% of CMS fee schedule,6.7,100,,,fee schedule,100% of CMS fee schedule,5.03,75,,,fee schedule,75% of CMS fee schedule,5.03,75,,,fee schedule,75% of CMS fee schedule,6.7,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.4,40,,29.12,percent of total billed charges,40% of total billed charges,5.03,72.8,
HELIBACT PYL ANT-IGM,7000169,CDM,302,RC,86677,HCPCS,Outpatient,,,132,105.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,49.2,37.27,,39.36,percent of total billed charges,37.27% of total billed charges,49.2,37.27,,39.36,percent of total billed charges,37.27% of total billed charges,49.2,37.27,,39.36,percent of total billed charges,37.27% of total billed charges,12.64,75,,,fee schedule,75% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,40,,42.24,percent of total billed charges,40% of total billed charges,12.64,105.6,
CREATININE CLEARANCE,7000029,CDM,301,RC,82575,HCPCS,Outpatient,,,53,42.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,7.1,75,,,fee schedule,75% of CMS fee schedule,7.1,75,,,fee schedule,75% of CMS fee schedule,9.46,100,,,fee schedule,100% of CMS fee schedule,9.46,100,,,fee schedule,100% of CMS fee schedule,7.1,75,,,fee schedule,75% of CMS fee schedule,7.1,75,,,fee schedule,75% of CMS fee schedule,9.46,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,7.1,42.4,
ACETONE URINE,7018237,CDM,307,RC,81005,HCPCS,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,1.63,75,,,fee schedule,75% of CMS fee schedule,1.63,75,,,fee schedule,75% of CMS fee schedule,2.17,100,,,fee schedule,100% of CMS fee schedule,2.17,100,,,fee schedule,100% of CMS fee schedule,1.63,75,,,fee schedule,75% of CMS fee schedule,1.63,75,,,fee schedule,75% of CMS fee schedule,2.17,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,1.63,10.4,
AFB SMEAR,7000284,CDM,306,RC,87206,HCPCS,Outpatient,,,29,23.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,4.04,75,,,fee schedule,75% of CMS fee schedule,4.04,75,,,fee schedule,75% of CMS fee schedule,5.39,100,,,fee schedule,100% of CMS fee schedule,5.39,100,,,fee schedule,100% of CMS fee schedule,4.04,75,,,fee schedule,75% of CMS fee schedule,4.04,75,,,fee schedule,75% of CMS fee schedule,5.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,4.04,23.2,
AFB CULTURE,7000284,CDM,306,RC,87116,HCPCS,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,8.1,75,,,fee schedule,75% of CMS fee schedule,8.1,75,,,fee schedule,75% of CMS fee schedule,10.8,100,,,fee schedule,100% of CMS fee schedule,10.8,100,,,fee schedule,100% of CMS fee schedule,8.1,75,,,fee schedule,75% of CMS fee schedule,8.1,75,,,fee schedule,75% of CMS fee schedule,10.8,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,8.1,59.2,
ACID PHOSPHATASE,7000029,CDM,301,RC,84060,HCPCS,Outpatient,,,42,33.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,5.73,75,,,fee schedule,75% of CMS fee schedule,5.73,75,,,fee schedule,75% of CMS fee schedule,7.64,100,,,fee schedule,100% of CMS fee schedule,7.64,100,,,fee schedule,100% of CMS fee schedule,5.73,75,,,fee schedule,75% of CMS fee schedule,5.73,75,,,fee schedule,75% of CMS fee schedule,7.64,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,40,,13.44,percent of total billed charges,40% of total billed charges,5.73,33.6,
ALKALINE PHOSPHATASE,7000029,CDM,301,RC,84075,HCPCS,Outpatient,,,28,22.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,3.89,75,,,fee schedule,75% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,3.89,22.4,
AMYLASE SERUM,7000029,CDM,301,RC,82150,HCPCS,Outpatient,,,36,28.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,4.86,75,,,fee schedule,75% of CMS fee schedule,4.86,75,,,fee schedule,75% of CMS fee schedule,6.48,100,,,fee schedule,100% of CMS fee schedule,6.48,100,,,fee schedule,100% of CMS fee schedule,4.86,75,,,fee schedule,75% of CMS fee schedule,4.86,75,,,fee schedule,75% of CMS fee schedule,6.48,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,4.86,28.8,
ASO TITER,7000169,CDM,302,RC,86060,HCPCS,Outpatient,,,42,33.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,5.48,75,,,fee schedule,75% of CMS fee schedule,5.48,75,,,fee schedule,75% of CMS fee schedule,7.3,100,,,fee schedule,100% of CMS fee schedule,7.3,100,,,fee schedule,100% of CMS fee schedule,5.48,75,,,fee schedule,75% of CMS fee schedule,5.48,75,,,fee schedule,75% of CMS fee schedule,7.3,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,40,,13.44,percent of total billed charges,40% of total billed charges,5.48,33.6,
SICKLEDEX,7000177,CDM,305,RC,85660,HCPCS,Outpatient,,,31,24.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,4.13,75,,,fee schedule,75% of CMS fee schedule,4.13,75,,,fee schedule,75% of CMS fee schedule,5.51,100,,,fee schedule,100% of CMS fee schedule,5.51,100,,,fee schedule,100% of CMS fee schedule,4.13,75,,,fee schedule,75% of CMS fee schedule,4.13,75,,,fee schedule,75% of CMS fee schedule,5.51,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,4.13,24.8,
BILIRUBIN DIRECT,7000029,CDM,301,RC,82248,HCPCS,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,3.77,75,,,fee schedule,75% of CMS fee schedule,3.77,75,,,fee schedule,75% of CMS fee schedule,5.02,100,,,fee schedule,100% of CMS fee schedule,5.02,100,,,fee schedule,100% of CMS fee schedule,3.77,75,,,fee schedule,75% of CMS fee schedule,3.77,75,,,fee schedule,75% of CMS fee schedule,5.02,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,3.77,16,
BLOOD CULTURE,7000284,CDM,306,RC,87040,HCPCS,Outpatient,,,60,48.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,7.74,75,,,fee schedule,75% of CMS fee schedule,7.74,75,,,fee schedule,75% of CMS fee schedule,10.32,100,,,fee schedule,100% of CMS fee schedule,10.32,100,,,fee schedule,100% of CMS fee schedule,7.74,75,,,fee schedule,75% of CMS fee schedule,7.74,75,,,fee schedule,75% of CMS fee schedule,10.32,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,40,,19.2,percent of total billed charges,40% of total billed charges,7.74,48,
FIBRINOGEN ANTIGEN,7000177,CDM,305,RC,85385,HCPCS,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,10.85,75,,,fee schedule,75% of CMS fee schedule,10.85,75,,,fee schedule,75% of CMS fee schedule,14.46,100,,,fee schedule,100% of CMS fee schedule,14.46,100,,,fee schedule,100% of CMS fee schedule,10.85,75,,,fee schedule,75% of CMS fee schedule,10.85,75,,,fee schedule,75% of CMS fee schedule,14.46,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,40,,16,percent of total billed charges,40% of total billed charges,10.85,40,
ARSENIC WHOLE BLOOD,7000029,CDM,301,RC,82175,HCPCS,Outpatient,,,133,106.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,14.23,75,,,fee schedule,75% of CMS fee schedule,14.23,75,,,fee schedule,75% of CMS fee schedule,18.97,100,,,fee schedule,100% of CMS fee schedule,18.97,100,,,fee schedule,100% of CMS fee schedule,14.23,75,,,fee schedule,75% of CMS fee schedule,14.23,75,,,fee schedule,75% of CMS fee schedule,18.97,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.2,40,,42.56,percent of total billed charges,40% of total billed charges,14.23,106.4,
CALCIUM,7000029,CDM,301,RC,82310,HCPCS,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,3.87,75,,,fee schedule,75% of CMS fee schedule,3.87,75,,,fee schedule,75% of CMS fee schedule,5.16,100,,,fee schedule,100% of CMS fee schedule,5.16,100,,,fee schedule,100% of CMS fee schedule,3.87,75,,,fee schedule,75% of CMS fee schedule,3.87,75,,,fee schedule,75% of CMS fee schedule,5.16,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,3.87,22.4,
"CALCIUM URINE, 24 HO",7000029,CDM,301,RC,82340,HCPCS,Outpatient,,,38,30.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,4.52,75,,,fee schedule,75% of CMS fee schedule,4.52,75,,,fee schedule,75% of CMS fee schedule,6.03,100,,,fee schedule,100% of CMS fee schedule,6.03,100,,,fee schedule,100% of CMS fee schedule,4.52,75,,,fee schedule,75% of CMS fee schedule,4.52,75,,,fee schedule,75% of CMS fee schedule,6.03,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,4.52,30.4,
MAGNESIUM SERUM,7000029,CDM,301,RC,83735,HCPCS,Outpatient,,,38,30.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,5.03,75,,,fee schedule,75% of CMS fee schedule,5.03,75,,,fee schedule,75% of CMS fee schedule,6.7,100,,,fee schedule,100% of CMS fee schedule,6.7,100,,,fee schedule,100% of CMS fee schedule,5.03,75,,,fee schedule,75% of CMS fee schedule,5.03,75,,,fee schedule,75% of CMS fee schedule,6.7,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,5.03,30.4,
CO2,7000029,CDM,301,RC,82374,HCPCS,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,3.66,75,,,fee schedule,75% of CMS fee schedule,3.66,75,,,fee schedule,75% of CMS fee schedule,4.88,100,,,fee schedule,100% of CMS fee schedule,4.88,100,,,fee schedule,100% of CMS fee schedule,3.66,75,,,fee schedule,75% of CMS fee schedule,3.66,75,,,fee schedule,75% of CMS fee schedule,4.88,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,3.66,21.6,
CATECHOLAMINES FRACT,7000029,CDM,301,RC,82384,HCPCS,Outpatient,,,157,125.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,58.51,37.27,,46.81,percent of total billed charges,37.27% of total billed charges,58.51,37.27,,46.81,percent of total billed charges,37.27% of total billed charges,58.51,37.27,,46.81,percent of total billed charges,37.27% of total billed charges,18.94,75,,,fee schedule,75% of CMS fee schedule,18.94,75,,,fee schedule,75% of CMS fee schedule,25.25,100,,,fee schedule,100% of CMS fee schedule,25.25,100,,,fee schedule,100% of CMS fee schedule,18.94,75,,,fee schedule,75% of CMS fee schedule,18.94,75,,,fee schedule,75% of CMS fee schedule,25.25,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.8,40,,50.24,percent of total billed charges,40% of total billed charges,18.94,125.6,
WBC HEMO DIFFERENTIA,7000177,CDM,305,RC,85004,HCPCS,Outpatient,,,38,30.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,4.85,75,,,fee schedule,75% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,4.85,30.4,
CHLORIDE SERUM,7000029,CDM,301,RC,82435,HCPCS,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,3.45,75,,,fee schedule,75% of CMS fee schedule,3.45,75,,,fee schedule,75% of CMS fee schedule,4.6,100,,,fee schedule,100% of CMS fee schedule,4.6,100,,,fee schedule,100% of CMS fee schedule,3.45,75,,,fee schedule,75% of CMS fee schedule,3.45,75,,,fee schedule,75% of CMS fee schedule,4.6,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,3.45,20,
BILIRUBIN TOTAL,7000029,CDM,301,RC,82247,HCPCS,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,3.77,75,,,fee schedule,75% of CMS fee schedule,3.77,75,,,fee schedule,75% of CMS fee schedule,5.02,100,,,fee schedule,100% of CMS fee schedule,5.02,100,,,fee schedule,100% of CMS fee schedule,3.77,75,,,fee schedule,75% of CMS fee schedule,3.77,75,,,fee schedule,75% of CMS fee schedule,5.02,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,3.77,16,
PREGNENOLONE,7000029,CDM,301,RC,84140,HCPCS,Outpatient,,,141,112.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,52.55,37.27,,42.04,percent of total billed charges,37.27% of total billed charges,52.55,37.27,,42.04,percent of total billed charges,37.27% of total billed charges,52.55,37.27,,42.04,percent of total billed charges,37.27% of total billed charges,15.5,75,,,fee schedule,75% of CMS fee schedule,15.5,75,,,fee schedule,75% of CMS fee schedule,20.67,100,,,fee schedule,100% of CMS fee schedule,20.67,100,,,fee schedule,100% of CMS fee schedule,15.5,75,,,fee schedule,75% of CMS fee schedule,15.5,75,,,fee schedule,75% of CMS fee schedule,20.67,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.4,40,,45.12,percent of total billed charges,40% of total billed charges,15.5,112.8,
ALBUMIN SERUM,7000029,CDM,301,RC,82040,HCPCS,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,3.71,75,,,fee schedule,75% of CMS fee schedule,3.71,75,,,fee schedule,75% of CMS fee schedule,4.95,100,,,fee schedule,100% of CMS fee schedule,4.95,100,,,fee schedule,100% of CMS fee schedule,3.71,75,,,fee schedule,75% of CMS fee schedule,3.71,75,,,fee schedule,75% of CMS fee schedule,4.95,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,3.71,21.6,
SEX HORMONE BINDING,7000029,CDM,301,RC,84270,HCPCS,Outpatient,,,139,111.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,51.81,37.27,,41.45,percent of total billed charges,37.27% of total billed charges,51.81,37.27,,41.45,percent of total billed charges,37.27% of total billed charges,51.81,37.27,,41.45,percent of total billed charges,37.27% of total billed charges,16.3,75,,,fee schedule,75% of CMS fee schedule,16.3,75,,,fee schedule,75% of CMS fee schedule,21.73,100,,,fee schedule,100% of CMS fee schedule,21.73,100,,,fee schedule,100% of CMS fee schedule,16.3,75,,,fee schedule,75% of CMS fee schedule,16.3,75,,,fee schedule,75% of CMS fee schedule,21.73,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.6,40,,44.48,percent of total billed charges,40% of total billed charges,16.3,111.2,
COLD AGGLUTINATIONS,7000169,CDM,302,RC,86157,HCPCS,Outpatient,,,38,30.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,6.05,75,,,fee schedule,75% of CMS fee schedule,6.05,75,,,fee schedule,75% of CMS fee schedule,8.06,100,,,fee schedule,100% of CMS fee schedule,8.06,100,,,fee schedule,100% of CMS fee schedule,6.05,75,,,fee schedule,75% of CMS fee schedule,6.05,75,,,fee schedule,75% of CMS fee schedule,8.06,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,6.05,30.4,
C-R-P,7000169,CDM,302,RC,86140,HCPCS,Outpatient,,,29,23.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,3.89,75,,,fee schedule,75% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,3.89,23.2,
CPK,7000029,CDM,301,RC,82550,HCPCS,Outpatient,,,38,30.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,4.88,75,,,fee schedule,75% of CMS fee schedule,4.88,75,,,fee schedule,75% of CMS fee schedule,6.51,100,,,fee schedule,100% of CMS fee schedule,6.51,100,,,fee schedule,100% of CMS fee schedule,4.88,75,,,fee schedule,75% of CMS fee schedule,4.88,75,,,fee schedule,75% of CMS fee schedule,6.51,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,4.88,30.4,
CRYOGLOBULIN,7000029,CDM,301,RC,82595,HCPCS,Outpatient,,,36,28.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,4.85,75,,,fee schedule,75% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,4.85,28.8,
URINE CULTURE,7000284,CDM,306,RC,87086,HCPCS,Outpatient,,,46,36.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,6.05,75,,,fee schedule,75% of CMS fee schedule,6.05,75,,,fee schedule,75% of CMS fee schedule,8.07,100,,,fee schedule,100% of CMS fee schedule,8.07,100,,,fee schedule,100% of CMS fee schedule,6.05,75,,,fee schedule,75% of CMS fee schedule,6.05,75,,,fee schedule,75% of CMS fee schedule,8.07,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,6.05,36.8,
PROTEIN C ACTIVITYY,7000177,CDM,305,RC,85303,HCPCS,Outpatient,,,196,156.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,10.38,75,,,fee schedule,75% of CMS fee schedule,10.38,75,,,fee schedule,75% of CMS fee schedule,13.84,100,,,fee schedule,100% of CMS fee schedule,13.84,100,,,fee schedule,100% of CMS fee schedule,10.38,75,,,fee schedule,75% of CMS fee schedule,10.38,75,,,fee schedule,75% of CMS fee schedule,13.84,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.4,40,,62.72,percent of total billed charges,40% of total billed charges,10.38,156.8,
STOOL CULTURE,7000284,CDM,306,RC,87045,HCPCS,Outpatient,,,63,50.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,7.08,75,,,fee schedule,75% of CMS fee schedule,7.08,75,,,fee schedule,75% of CMS fee schedule,9.44,100,,,fee schedule,100% of CMS fee schedule,9.44,100,,,fee schedule,100% of CMS fee schedule,7.08,75,,,fee schedule,75% of CMS fee schedule,7.08,75,,,fee schedule,75% of CMS fee schedule,9.44,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,40,,20.16,percent of total billed charges,40% of total billed charges,7.08,50.4,
STOOL FAT,7000029,CDM,301,RC,82705,HCPCS,Outpatient,,,94,75.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,3.83,75,,,fee schedule,75% of CMS fee schedule,3.83,75,,,fee schedule,75% of CMS fee schedule,5.1,100,,,fee schedule,100% of CMS fee schedule,5.1,100,,,fee schedule,100% of CMS fee schedule,3.83,75,,,fee schedule,75% of CMS fee schedule,3.83,75,,,fee schedule,75% of CMS fee schedule,5.1,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,3.83,75.2,
PROTEIN S ACTIVITY,7000177,CDM,305,RC,85306,HCPCS,Outpatient,,,203,162.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,11.49,75,,,fee schedule,75% of CMS fee schedule,11.49,75,,,fee schedule,75% of CMS fee schedule,15.32,100,,,fee schedule,100% of CMS fee schedule,15.32,100,,,fee schedule,100% of CMS fee schedule,11.49,75,,,fee schedule,75% of CMS fee schedule,11.49,75,,,fee schedule,75% of CMS fee schedule,15.32,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.2,40,,64.96,percent of total billed charges,40% of total billed charges,11.49,162.4,
FUNGUS CULTR-OTH SRC,7000284,CDM,306,RC,87102,HCPCS,Outpatient,,,66,52.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,6.31,75,,,fee schedule,75% of CMS fee schedule,6.31,75,,,fee schedule,75% of CMS fee schedule,8.41,100,,,fee schedule,100% of CMS fee schedule,8.41,100,,,fee schedule,100% of CMS fee schedule,6.31,75,,,fee schedule,75% of CMS fee schedule,6.31,75,,,fee schedule,75% of CMS fee schedule,8.41,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,6.31,52.8,
SPUTUM CULTURE,7000284,CDM,306,RC,87070,HCPCS,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,6.47,75,,,fee schedule,75% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,6.47,39.2,
THROAT CULTURE,7000284,CDM,306,RC,87070,HCPCS,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,6.47,75,,,fee schedule,75% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,6.47,39.2,
CHOLESTEROL,7000029,CDM,301,RC,82465,HCPCS,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,3.26,75,,,fee schedule,75% of CMS fee schedule,3.26,75,,,fee schedule,75% of CMS fee schedule,4.35,100,,,fee schedule,100% of CMS fee schedule,4.35,100,,,fee schedule,100% of CMS fee schedule,3.26,75,,,fee schedule,75% of CMS fee schedule,3.26,75,,,fee schedule,75% of CMS fee schedule,4.35,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,3.26,19.2,
SPINAL FLUID CULTURE,7000284,CDM,306,RC,87070,HCPCS,Outpatient,,,63,50.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,6.47,75,,,fee schedule,75% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,40,,20.16,percent of total billed charges,40% of total billed charges,6.47,50.4,
MISC CULTURE,7000284,CDM,306,RC,87070,HCPCS,Outpatient,,,56,44.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,6.47,75,,,fee schedule,75% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,40,,17.92,percent of total billed charges,40% of total billed charges,6.47,44.8,
BLOOD SUGAR,7000029,CDM,301,RC,82947,HCPCS,Outpatient,,,21,16.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,2.95,75,,,fee schedule,75% of CMS fee schedule,2.95,75,,,fee schedule,75% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,2.95,75,,,fee schedule,75% of CMS fee schedule,2.95,75,,,fee schedule,75% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,2.95,16.8,
GLUCOSE TOL 3 HRS,7000029,CDM,301,RC,82951,HCPCS,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,9.65,75,,,fee schedule,75% of CMS fee schedule,9.65,75,,,fee schedule,75% of CMS fee schedule,12.87,100,,,fee schedule,100% of CMS fee schedule,12.87,100,,,fee schedule,100% of CMS fee schedule,9.65,75,,,fee schedule,75% of CMS fee schedule,9.65,75,,,fee schedule,75% of CMS fee schedule,12.87,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,9.65,58.4,
HEMOGLOBIN,7000177,CDM,305,RC,85018,HCPCS,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,1.78,75,,,fee schedule,75% of CMS fee schedule,1.78,75,,,fee schedule,75% of CMS fee schedule,2.37,100,,,fee schedule,100% of CMS fee schedule,2.37,100,,,fee schedule,100% of CMS fee schedule,1.78,75,,,fee schedule,75% of CMS fee schedule,1.78,75,,,fee schedule,75% of CMS fee schedule,2.37,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,1.78,11.2,
PORPHOBILINOGEN URIN,7000029,CDM,301,RC,84110,HCPCS,Outpatient,,,55,44.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,6.33,75,,,fee schedule,75% of CMS fee schedule,6.33,75,,,fee schedule,75% of CMS fee schedule,8.44,100,,,fee schedule,100% of CMS fee schedule,8.44,100,,,fee schedule,100% of CMS fee schedule,6.33,75,,,fee schedule,75% of CMS fee schedule,6.33,75,,,fee schedule,75% of CMS fee schedule,8.44,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22,40,,17.6,percent of total billed charges,40% of total billed charges,6.33,44,
MONOSPOT,7000169,CDM,302,RC,86308,HCPCS,Outpatient,,,32,25.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,3.89,75,,,fee schedule,75% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,40,,10.24,percent of total billed charges,40% of total billed charges,3.89,25.6,
SPINAL FLUID ROUTINE,7000177,CDM,305,RC,89051,HCPCS,Outpatient,,,108,86.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,4.2,75,,,fee schedule,75% of CMS fee schedule,4.2,75,,,fee schedule,75% of CMS fee schedule,5.6,100,,,fee schedule,100% of CMS fee schedule,5.6,100,,,fee schedule,100% of CMS fee schedule,4.2,75,,,fee schedule,75% of CMS fee schedule,4.2,75,,,fee schedule,75% of CMS fee schedule,5.6,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,4.2,86.4,
5 HYDROXYINDOLEACETI,7000029,CDM,301,RC,83497,HCPCS,Outpatient,,,109,87.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,9.68,75,,,fee schedule,75% of CMS fee schedule,9.68,75,,,fee schedule,75% of CMS fee schedule,12.9,100,,,fee schedule,100% of CMS fee schedule,12.9,100,,,fee schedule,100% of CMS fee schedule,9.68,75,,,fee schedule,75% of CMS fee schedule,9.68,75,,,fee schedule,75% of CMS fee schedule,12.9,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.6,40,,34.88,percent of total billed charges,40% of total billed charges,9.68,87.2,
VMA URINE,7000029,CDM,301,RC,84585,HCPCS,Outpatient,,,132,105.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,49.2,37.27,,39.36,percent of total billed charges,37.27% of total billed charges,49.2,37.27,,39.36,percent of total billed charges,37.27% of total billed charges,49.2,37.27,,39.36,percent of total billed charges,37.27% of total billed charges,11.63,75,,,fee schedule,75% of CMS fee schedule,11.63,75,,,fee schedule,75% of CMS fee schedule,15.5,100,,,fee schedule,100% of CMS fee schedule,15.5,100,,,fee schedule,100% of CMS fee schedule,11.63,75,,,fee schedule,75% of CMS fee schedule,11.63,75,,,fee schedule,75% of CMS fee schedule,15.5,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,40,,42.24,percent of total billed charges,40% of total billed charges,11.63,105.6,
IRON SERUM,7000029,CDM,301,RC,83540,HCPCS,Outpatient,,,43,34.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,4.85,75,,,fee schedule,75% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.2,40,,13.76,percent of total billed charges,40% of total billed charges,4.85,34.4,
IRON BINDING CAP,7000029,CDM,301,RC,83550,HCPCS,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,6.56,75,,,fee schedule,75% of CMS fee schedule,6.56,75,,,fee schedule,75% of CMS fee schedule,8.74,100,,,fee schedule,100% of CMS fee schedule,8.74,100,,,fee schedule,100% of CMS fee schedule,6.56,75,,,fee schedule,75% of CMS fee schedule,6.56,75,,,fee schedule,75% of CMS fee schedule,8.74,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,6.56,39.2,
LDH,7000029,CDM,301,RC,83615,HCPCS,Outpatient,,,34,27.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,4.53,75,,,fee schedule,75% of CMS fee schedule,4.53,75,,,fee schedule,75% of CMS fee schedule,6.04,100,,,fee schedule,100% of CMS fee schedule,6.04,100,,,fee schedule,100% of CMS fee schedule,4.53,75,,,fee schedule,75% of CMS fee schedule,4.53,75,,,fee schedule,75% of CMS fee schedule,6.04,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,4.53,27.2,
RHEUMATOID AGG,7000169,CDM,302,RC,86431,HCPCS,Outpatient,,,31,24.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,4.25,75,,,fee schedule,75% of CMS fee schedule,4.25,75,,,fee schedule,75% of CMS fee schedule,5.67,100,,,fee schedule,100% of CMS fee schedule,5.67,100,,,fee schedule,100% of CMS fee schedule,4.25,75,,,fee schedule,75% of CMS fee schedule,4.25,75,,,fee schedule,75% of CMS fee schedule,5.67,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,4.25,24.8,
LEAD,7000029,CDM,301,RC,83655,HCPCS,Outpatient,,,67,53.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,9.08,75,,,fee schedule,75% of CMS fee schedule,9.08,75,,,fee schedule,75% of CMS fee schedule,12.11,100,,,fee schedule,100% of CMS fee schedule,12.11,100,,,fee schedule,100% of CMS fee schedule,9.08,75,,,fee schedule,75% of CMS fee schedule,9.08,75,,,fee schedule,75% of CMS fee schedule,12.11,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,9.08,53.6,
LIPOPROTEIN QUANTITA,7000029,CDM,301,RC,83704,HCPCS,Outpatient,,,172,137.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% of total billed charges,25.64,75,,,fee schedule,75% of CMS fee schedule,25.64,75,,,fee schedule,75% of CMS fee schedule,34.19,100,,,fee schedule,100% of CMS fee schedule,34.19,100,,,fee schedule,100% of CMS fee schedule,25.64,75,,,fee schedule,75% of CMS fee schedule,25.64,75,,,fee schedule,75% of CMS fee schedule,34.19,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.8,40,,55.04,percent of total billed charges,40% of total billed charges,25.64,137.6,
OCCULT BLOOD FECES,7000029,CDM,301,RC,82270,HCPCS,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,3.29,75,,,fee schedule,75% of CMS fee schedule,3.29,75,,,fee schedule,75% of CMS fee schedule,4.38,100,,,fee schedule,100% of CMS fee schedule,4.38,100,,,fee schedule,100% of CMS fee schedule,3.29,75,,,fee schedule,75% of CMS fee schedule,3.29,75,,,fee schedule,75% of CMS fee schedule,4.38,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,3.29,14.4,
O&P FECES EXAM,7000284,CDM,306,RC,87177,HCPCS,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,6.68,75,,,fee schedule,75% of CMS fee schedule,6.68,75,,,fee schedule,75% of CMS fee schedule,8.9,100,,,fee schedule,100% of CMS fee schedule,8.9,100,,,fee schedule,100% of CMS fee schedule,6.68,75,,,fee schedule,75% of CMS fee schedule,6.68,75,,,fee schedule,75% of CMS fee schedule,8.9,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,40,,16,percent of total billed charges,40% of total billed charges,6.68,40,
"PHOSPHORUS, SERUM",7000029,CDM,301,RC,84100,HCPCS,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,3.56,75,,,fee schedule,75% of CMS fee schedule,3.56,75,,,fee schedule,75% of CMS fee schedule,4.74,100,,,fee schedule,100% of CMS fee schedule,4.74,100,,,fee schedule,100% of CMS fee schedule,3.56,75,,,fee schedule,75% of CMS fee schedule,3.56,75,,,fee schedule,75% of CMS fee schedule,4.74,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,3.56,21.6,
PLATELETS,7000177,CDM,305,RC,85049,HCPCS,Outpatient,,,22,17.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,3.36,75,,,fee schedule,75% of CMS fee schedule,3.36,75,,,fee schedule,75% of CMS fee schedule,4.48,100,,,fee schedule,100% of CMS fee schedule,4.48,100,,,fee schedule,100% of CMS fee schedule,3.36,75,,,fee schedule,75% of CMS fee schedule,3.36,75,,,fee schedule,75% of CMS fee schedule,4.48,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,3.36,17.6,
"PORPHYRINS, FRACT, U",7000029,CDM,301,RC,84120,HCPCS,Outpatient,,,132,105.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,49.2,37.27,,39.36,percent of total billed charges,37.27% of total billed charges,49.2,37.27,,39.36,percent of total billed charges,37.27% of total billed charges,49.2,37.27,,39.36,percent of total billed charges,37.27% of total billed charges,11.03,75,,,fee schedule,75% of CMS fee schedule,11.03,75,,,fee schedule,75% of CMS fee schedule,14.71,100,,,fee schedule,100% of CMS fee schedule,14.71,100,,,fee schedule,100% of CMS fee schedule,11.03,75,,,fee schedule,75% of CMS fee schedule,11.03,75,,,fee schedule,75% of CMS fee schedule,14.71,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,40,,42.24,percent of total billed charges,40% of total billed charges,11.03,105.6,
POST P SUGAR,7000029,CDM,301,RC,82947,HCPCS,Outpatient,,,38,30.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,2.95,75,,,fee schedule,75% of CMS fee schedule,2.95,75,,,fee schedule,75% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,2.95,75,,,fee schedule,75% of CMS fee schedule,2.95,75,,,fee schedule,75% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,2.95,30.4,
"POTASSIUM, SERUM",7000029,CDM,301,RC,84132,HCPCS,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,3.57,75,,,fee schedule,75% of CMS fee schedule,3.57,75,,,fee schedule,75% of CMS fee schedule,4.76,100,,,fee schedule,100% of CMS fee schedule,4.76,100,,,fee schedule,100% of CMS fee schedule,3.57,75,,,fee schedule,75% of CMS fee schedule,3.57,75,,,fee schedule,75% of CMS fee schedule,4.76,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,3.57,20,
COPPER,7000029,CDM,301,RC,82525,HCPCS,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,9.31,75,,,fee schedule,75% of CMS fee schedule,9.31,75,,,fee schedule,75% of CMS fee schedule,12.41,100,,,fee schedule,100% of CMS fee schedule,12.41,100,,,fee schedule,100% of CMS fee schedule,9.31,75,,,fee schedule,75% of CMS fee schedule,9.31,75,,,fee schedule,75% of CMS fee schedule,12.41,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28,40,,22.4,percent of total billed charges,40% of total billed charges,9.31,56,
TOTAL PROTEIN,7000029,CDM,301,RC,84155,HCPCS,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,2.75,75,,,fee schedule,75% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,2.75,16,
PROTEIN ELECTROPH S,7000029,CDM,301,RC,84165,HCPCS,Outpatient,,,60,48.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,8.06,75,,,fee schedule,75% of CMS fee schedule,8.06,75,,,fee schedule,75% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,8.06,75,,,fee schedule,75% of CMS fee schedule,8.06,75,,,fee schedule,75% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,40,,19.2,percent of total billed charges,40% of total billed charges,8.06,48,
PROTEIN TOTAL 24 URI,7000029,CDM,301,RC,84156,HCPCS,Outpatient,,,27,21.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,2.75,75,,,fee schedule,75% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,2.75,21.6,
PROTHROMBIN,7000177,CDM,305,RC,85610,HCPCS,Outpatient,,,21,16.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,3.22,75,,,fee schedule,75% of CMS fee schedule,3.22,75,,,fee schedule,75% of CMS fee schedule,4.29,100,,,fee schedule,100% of CMS fee schedule,4.29,100,,,fee schedule,100% of CMS fee schedule,3.22,75,,,fee schedule,75% of CMS fee schedule,3.22,75,,,fee schedule,75% of CMS fee schedule,4.29,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,3.22,16.8,
SALICYLATES,7000029,CDM,301,RC,80179,HCPCS,Outpatient,,,280,224.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224,80,,179.2,percent of total billed charges,80% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% of total billed charges,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112,40,,89.6,percent of total billed charges,40% of total billed charges,13.98,224,
SEDIMENTATION RATE,7000177,CDM,305,RC,85651,HCPCS,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,3.2,16,
"AMMONIA, BLOOD",7000029,CDM,301,RC,82140,HCPCS,Outpatient,,,81,64.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,10.93,75,,,fee schedule,75% of CMS fee schedule,10.93,75,,,fee schedule,75% of CMS fee schedule,14.57,100,,,fee schedule,100% of CMS fee schedule,14.57,100,,,fee schedule,100% of CMS fee schedule,10.93,75,,,fee schedule,75% of CMS fee schedule,10.93,75,,,fee schedule,75% of CMS fee schedule,14.57,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,40,,25.92,percent of total billed charges,40% of total billed charges,10.93,64.8,
"SODIUM, URINE",7000029,CDM,301,RC,84300,HCPCS,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,3.8,75,,,fee schedule,75% of CMS fee schedule,3.8,75,,,fee schedule,75% of CMS fee schedule,5.06,100,,,fee schedule,100% of CMS fee schedule,5.06,100,,,fee schedule,100% of CMS fee schedule,3.8,75,,,fee schedule,75% of CMS fee schedule,3.8,75,,,fee schedule,75% of CMS fee schedule,5.06,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,3.8,21.6,
"SODIUM, SERUM",7000029,CDM,301,RC,84295,HCPCS,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,3.61,75,,,fee schedule,75% of CMS fee schedule,3.61,75,,,fee schedule,75% of CMS fee schedule,4.81,100,,,fee schedule,100% of CMS fee schedule,4.81,100,,,fee schedule,100% of CMS fee schedule,3.61,75,,,fee schedule,75% of CMS fee schedule,3.61,75,,,fee schedule,75% of CMS fee schedule,4.81,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,3.61,21.6,
"LITHIUM, SERUM",7000029,CDM,301,RC,80178,HCPCS,Outpatient,,,45,36.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,4.96,75,,,fee schedule,75% of CMS fee schedule,4.96,75,,,fee schedule,75% of CMS fee schedule,6.61,100,,,fee schedule,100% of CMS fee schedule,6.61,100,,,fee schedule,100% of CMS fee schedule,4.96,75,,,fee schedule,75% of CMS fee schedule,4.96,75,,,fee schedule,75% of CMS fee schedule,6.61,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,40,,14.4,percent of total billed charges,40% of total billed charges,4.96,36,
STONE CHEM. ANAL.,7000029,CDM,301,RC,82355,HCPCS,Outpatient,,,64,51.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,8.69,75,,,fee schedule,75% of CMS fee schedule,8.69,75,,,fee schedule,75% of CMS fee schedule,11.58,100,,,fee schedule,100% of CMS fee schedule,11.58,100,,,fee schedule,100% of CMS fee schedule,8.69,75,,,fee schedule,75% of CMS fee schedule,8.69,75,,,fee schedule,75% of CMS fee schedule,11.58,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,8.69,51.2,
TRYPSIN FECAL,7000029,CDM,301,RC,84488,HCPCS,Outpatient,,,183,146.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% of total billed charges,5.48,75,,,fee schedule,75% of CMS fee schedule,5.48,75,,,fee schedule,75% of CMS fee schedule,7.3,100,,,fee schedule,100% of CMS fee schedule,7.3,100,,,fee schedule,100% of CMS fee schedule,5.48,75,,,fee schedule,75% of CMS fee schedule,5.48,75,,,fee schedule,75% of CMS fee schedule,7.3,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,40,,58.56,percent of total billed charges,40% of total billed charges,5.48,146.4,
QUANT. VDRL,7000169,CDM,302,RC,86593,HCPCS,Outpatient,,,36,28.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,3.3,75,,,fee schedule,75% of CMS fee schedule,3.3,75,,,fee schedule,75% of CMS fee schedule,4.4,100,,,fee schedule,100% of CMS fee schedule,4.4,100,,,fee schedule,100% of CMS fee schedule,3.3,75,,,fee schedule,75% of CMS fee schedule,3.3,75,,,fee schedule,75% of CMS fee schedule,4.4,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,3.3,28.8,
BUN,7000029,CDM,301,RC,84520,HCPCS,Outpatient,,,21,16.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,2.96,75,,,fee schedule,75% of CMS fee schedule,2.96,75,,,fee schedule,75% of CMS fee schedule,3.95,100,,,fee schedule,100% of CMS fee schedule,3.95,100,,,fee schedule,100% of CMS fee schedule,2.96,75,,,fee schedule,75% of CMS fee schedule,2.96,75,,,fee schedule,75% of CMS fee schedule,3.95,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,2.96,16.8,
"URIC ACID, SERUM",7000029,CDM,301,RC,84550,HCPCS,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,3.39,75,,,fee schedule,75% of CMS fee schedule,3.39,75,,,fee schedule,75% of CMS fee schedule,4.52,100,,,fee schedule,100% of CMS fee schedule,4.52,100,,,fee schedule,100% of CMS fee schedule,3.39,75,,,fee schedule,75% of CMS fee schedule,3.39,75,,,fee schedule,75% of CMS fee schedule,4.52,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,3.39,20,
VDRL,7000169,CDM,302,RC,86592,HCPCS,Outpatient,,,31,24.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,3.2,24.8,
MISC. SMEAR,7000284,CDM,306,RC,87205,HCPCS,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,3.2,19.2,
CAFFEINE LEVEL,7000029,CDM,301,RC,80155,HCPCS,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,28.93,75,,,fee schedule,75% of CMS fee schedule,28.93,75,,,fee schedule,75% of CMS fee schedule,38.57,100,,,fee schedule,100% of CMS fee schedule,38.57,100,,,fee schedule,100% of CMS fee schedule,28.93,75,,,fee schedule,75% of CMS fee schedule,28.93,75,,,fee schedule,75% of CMS fee schedule,38.57,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34,40,,27.2,percent of total billed charges,40% of total billed charges,28.93,68,
PARVOVIRUS B19 IGM,7000169,CDM,302,RC,86747,HCPCS,Outpatient,,,113,90.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,11.27,75,,,fee schedule,75% of CMS fee schedule,11.27,75,,,fee schedule,75% of CMS fee schedule,15.03,100,,,fee schedule,100% of CMS fee schedule,15.03,100,,,fee schedule,100% of CMS fee schedule,11.27,75,,,fee schedule,75% of CMS fee schedule,11.27,75,,,fee schedule,75% of CMS fee schedule,15.03,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.2,40,,36.16,percent of total billed charges,40% of total billed charges,11.27,90.4,
"TESTOSTERONE, FREE",7000029,CDM,301,RC,84402,HCPCS,Outpatient,,,143,114.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% of total billed charges,19.1,75,,,fee schedule,75% of CMS fee schedule,19.1,75,,,fee schedule,75% of CMS fee schedule,25.47,100,,,fee schedule,100% of CMS fee schedule,25.47,100,,,fee schedule,100% of CMS fee schedule,19.1,75,,,fee schedule,75% of CMS fee schedule,19.1,75,,,fee schedule,75% of CMS fee schedule,25.47,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.2,40,,45.76,percent of total billed charges,40% of total billed charges,19.1,114.4,
SGPT,7000029,CDM,301,RC,84460,HCPCS,Outpatient,,,29,23.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,3.98,75,,,fee schedule,75% of CMS fee schedule,3.98,75,,,fee schedule,75% of CMS fee schedule,5.3,100,,,fee schedule,100% of CMS fee schedule,5.3,100,,,fee schedule,100% of CMS fee schedule,3.98,75,,,fee schedule,75% of CMS fee schedule,3.98,75,,,fee schedule,75% of CMS fee schedule,5.3,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,3.98,23.2,
"METANEPHRINES, FRACT",7000029,CDM,301,RC,83835,HCPCS,Outpatient,,,134,107.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,12.71,75,,,fee schedule,75% of CMS fee schedule,12.71,75,,,fee schedule,75% of CMS fee schedule,16.94,100,,,fee schedule,100% of CMS fee schedule,16.94,100,,,fee schedule,100% of CMS fee schedule,12.71,75,,,fee schedule,75% of CMS fee schedule,12.71,75,,,fee schedule,75% of CMS fee schedule,16.94,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,40,,42.88,percent of total billed charges,40% of total billed charges,12.71,107.2,
T3,7000029,CDM,301,RC,84480,HCPCS,Outpatient,,,55,44.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,10.64,75,,,fee schedule,75% of CMS fee schedule,10.64,75,,,fee schedule,75% of CMS fee schedule,14.18,100,,,fee schedule,100% of CMS fee schedule,14.18,100,,,fee schedule,100% of CMS fee schedule,10.64,75,,,fee schedule,75% of CMS fee schedule,10.64,75,,,fee schedule,75% of CMS fee schedule,14.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22,40,,17.6,percent of total billed charges,40% of total billed charges,10.64,44,
TRIGLYCERIDES,7000029,CDM,301,RC,84478,HCPCS,Outpatient,,,32,25.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,4.31,75,,,fee schedule,75% of CMS fee schedule,4.31,75,,,fee schedule,75% of CMS fee schedule,5.74,100,,,fee schedule,100% of CMS fee schedule,5.74,100,,,fee schedule,100% of CMS fee schedule,4.31,75,,,fee schedule,75% of CMS fee schedule,4.31,75,,,fee schedule,75% of CMS fee schedule,5.74,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,40,,10.24,percent of total billed charges,40% of total billed charges,4.31,25.6,
PTT,7000177,CDM,305,RC,85730,HCPCS,Outpatient,,,34,27.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,4.51,75,,,fee schedule,75% of CMS fee schedule,4.51,75,,,fee schedule,75% of CMS fee schedule,6.01,100,,,fee schedule,100% of CMS fee schedule,6.01,100,,,fee schedule,100% of CMS fee schedule,4.51,75,,,fee schedule,75% of CMS fee schedule,4.51,75,,,fee schedule,75% of CMS fee schedule,6.01,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,4.51,27.2,
URINALYSIS,7018237,CDM,307,RC,81001,HCPCS,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,2.38,75,,,fee schedule,75% of CMS fee schedule,2.38,75,,,fee schedule,75% of CMS fee schedule,3.17,100,,,fee schedule,100% of CMS fee schedule,3.17,100,,,fee schedule,100% of CMS fee schedule,2.38,75,,,fee schedule,75% of CMS fee schedule,2.38,75,,,fee schedule,75% of CMS fee schedule,3.17,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,2.38,19.2,
VANCOMYCIN TROUGH,7000029,CDM,301,RC,80202,HCPCS,Outpatient,,,122,97.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,10.16,75,,,fee schedule,75% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.8,40,,39.04,percent of total billed charges,40% of total billed charges,10.16,97.6,
CPK ISOENZYME,7000029,CDM,301,RC,82552,HCPCS,Outpatient,,,76,60.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,10.04,75,,,fee schedule,75% of CMS fee schedule,10.04,75,,,fee schedule,75% of CMS fee schedule,13.39,100,,,fee schedule,100% of CMS fee schedule,13.39,100,,,fee schedule,100% of CMS fee schedule,10.04,75,,,fee schedule,75% of CMS fee schedule,10.04,75,,,fee schedule,75% of CMS fee schedule,13.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,40,,24.32,percent of total billed charges,40% of total billed charges,10.04,60.8,
WBC SEROLOGY,7000177,CDM,305,RC,89051,HCPCS,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,4.2,75,,,fee schedule,75% of CMS fee schedule,4.2,75,,,fee schedule,75% of CMS fee schedule,5.6,100,,,fee schedule,100% of CMS fee schedule,5.6,100,,,fee schedule,100% of CMS fee schedule,4.2,75,,,fee schedule,75% of CMS fee schedule,4.2,75,,,fee schedule,75% of CMS fee schedule,5.6,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,4.2,31.2,
"LACTOFERRIN, FECAL",7000029,CDM,301,RC,83630,HCPCS,Outpatient,,,64,51.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,14.78,75,,,fee schedule,75% of CMS fee schedule,14.78,75,,,fee schedule,75% of CMS fee schedule,19.7,100,,,fee schedule,100% of CMS fee schedule,19.7,100,,,fee schedule,100% of CMS fee schedule,14.78,75,,,fee schedule,75% of CMS fee schedule,14.78,75,,,fee schedule,75% of CMS fee schedule,19.7,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,14.78,51.2,
LEVETIRACETAM LEVEL,7000029,CDM,301,RC,80177,HCPCS,Outpatient,,,151,120.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% of total billed charges,9.94,75,,,fee schedule,75% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.4,40,,48.32,percent of total billed charges,40% of total billed charges,9.94,120.8,
"URINE,MICROALBUMIN",7000029,CDM,301,RC,82043,HCPCS,Outpatient,,,127,101.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% of total billed charges,4.34,75,,,fee schedule,75% of CMS fee schedule,4.34,75,,,fee schedule,75% of CMS fee schedule,5.78,100,,,fee schedule,100% of CMS fee schedule,5.78,100,,,fee schedule,100% of CMS fee schedule,4.34,75,,,fee schedule,75% of CMS fee schedule,4.34,75,,,fee schedule,75% of CMS fee schedule,5.78,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.8,40,,40.64,percent of total billed charges,40% of total billed charges,4.34,101.6,
"SEROTONIN, SERUM",7000029,CDM,301,RC,84260,HCPCS,Outpatient,,,461,368.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368.8,80,,295.04,percent of total billed charges,80% of total billed charges,171.81,37.27,,137.45,percent of total billed charges,37.27% of total billed charges,171.81,37.27,,137.45,percent of total billed charges,37.27% of total billed charges,171.81,37.27,,137.45,percent of total billed charges,37.27% of total billed charges,23.24,75,,,fee schedule,75% of CMS fee schedule,23.24,75,,,fee schedule,75% of CMS fee schedule,30.98,100,,,fee schedule,100% of CMS fee schedule,30.98,100,,,fee schedule,100% of CMS fee schedule,23.24,75,,,fee schedule,75% of CMS fee schedule,23.24,75,,,fee schedule,75% of CMS fee schedule,30.98,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.4,40,,147.52,percent of total billed charges,40% of total billed charges,23.24,368.8,
PSA SCREENING,7012032,CDM,300,RC,G0103,HCPCS,Outpatient,,,102,81.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% of total billed charges,14.48,75,,,fee schedule,75% of CMS fee schedule,14.48,75,,,fee schedule,75% of CMS fee schedule,19.31,100,,,fee schedule,100% of CMS fee schedule,19.31,100,,,fee schedule,100% of CMS fee schedule,14.48,75,,,fee schedule,75% of CMS fee schedule,14.48,75,,,fee schedule,75% of CMS fee schedule,19.31,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,40,,32.64,percent of total billed charges,40% of total billed charges,14.48,81.6,
STREP A SCREEN,7000284,CDM,306,RC,87880,HCPCS,Outpatient,,,67,53.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,12.4,75,,,fee schedule,75% of CMS fee schedule,12.4,75,,,fee schedule,75% of CMS fee schedule,16.53,100,,,fee schedule,100% of CMS fee schedule,16.53,100,,,fee schedule,100% of CMS fee schedule,12.4,75,,,fee schedule,75% of CMS fee schedule,12.4,75,,,fee schedule,75% of CMS fee schedule,16.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,12.4,53.6,
LIPID PANEL,7000029,CDM,301,RC,80061,HCPCS,Outpatient,,,67,53.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,10.04,75,,,fee schedule,75% of CMS fee schedule,10.04,75,,,fee schedule,75% of CMS fee schedule,13.39,100,,,fee schedule,100% of CMS fee schedule,13.39,100,,,fee schedule,100% of CMS fee schedule,10.04,75,,,fee schedule,75% of CMS fee schedule,10.04,75,,,fee schedule,75% of CMS fee schedule,13.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,10.04,53.6,
MUMPS ANITBODY IGG O,7000169,CDM,302,RC,86735,HCPCS,Outpatient,,,141,112.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,52.55,37.27,,42.04,percent of total billed charges,37.27% of total billed charges,52.55,37.27,,42.04,percent of total billed charges,37.27% of total billed charges,52.55,37.27,,42.04,percent of total billed charges,37.27% of total billed charges,9.79,75,,,fee schedule,75% of CMS fee schedule,9.79,75,,,fee schedule,75% of CMS fee schedule,13.05,100,,,fee schedule,100% of CMS fee schedule,13.05,100,,,fee schedule,100% of CMS fee schedule,9.79,75,,,fee schedule,75% of CMS fee schedule,9.79,75,,,fee schedule,75% of CMS fee schedule,13.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.4,40,,45.12,percent of total billed charges,40% of total billed charges,9.79,112.8,
HEP B SUR ANTIBIO OB,7000169,CDM,302,RC,86706,HCPCS,Outpatient,,,60,48.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,8.06,75,,,fee schedule,75% of CMS fee schedule,8.06,75,,,fee schedule,75% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,8.06,75,,,fee schedule,75% of CMS fee schedule,8.06,75,,,fee schedule,75% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,40,,19.2,percent of total billed charges,40% of total billed charges,8.06,48,
"IMMUNOGLOBULIN G, SU",7000029,CDM,301,RC,82787,HCPCS,Outpatient,,,91,72.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,6.02,75,,,fee schedule,75% of CMS fee schedule,6.02,75,,,fee schedule,75% of CMS fee schedule,8.02,100,,,fee schedule,100% of CMS fee schedule,8.02,100,,,fee schedule,100% of CMS fee schedule,6.02,75,,,fee schedule,75% of CMS fee schedule,6.02,75,,,fee schedule,75% of CMS fee schedule,8.02,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.4,40,,29.12,percent of total billed charges,40% of total billed charges,6.02,72.8,
BORDETELLA PERTUSSIS,7000284,CDM,306,RC,87265,HCPCS,Outpatient,,,73,58.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,8.99,75,,,fee schedule,75% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,8.99,58.4,
CKMB,7000029,CDM,301,RC,82553,HCPCS,Outpatient,,,64,51.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,8.66,75,,,fee schedule,75% of CMS fee schedule,8.66,75,,,fee schedule,75% of CMS fee schedule,11.55,100,,,fee schedule,100% of CMS fee schedule,11.55,100,,,fee schedule,100% of CMS fee schedule,8.66,75,,,fee schedule,75% of CMS fee schedule,8.66,75,,,fee schedule,75% of CMS fee schedule,11.55,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,8.66,51.2,
AMNIOSTAT,7000029,CDM,301,RC,84081,HCPCS,Outpatient,,,108,86.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,12.39,75,,,fee schedule,75% of CMS fee schedule,12.39,75,,,fee schedule,75% of CMS fee schedule,16.52,100,,,fee schedule,100% of CMS fee schedule,16.52,100,,,fee schedule,100% of CMS fee schedule,12.39,75,,,fee schedule,75% of CMS fee schedule,12.39,75,,,fee schedule,75% of CMS fee schedule,16.52,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,12.39,86.4,
TOXOPLASMA AB IGG,7000169,CDM,302,RC,86777,HCPCS,Outpatient,,,91,72.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,10.79,75,,,fee schedule,75% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.4,40,,29.12,percent of total billed charges,40% of total billed charges,10.79,72.8,
TOXOPLASMA AB IGM,7000169,CDM,302,RC,86778,HCPCS,Outpatient,,,91,72.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,10.81,75,,,fee schedule,75% of CMS fee schedule,10.81,75,,,fee schedule,75% of CMS fee schedule,14.41,100,,,fee schedule,100% of CMS fee schedule,14.41,100,,,fee schedule,100% of CMS fee schedule,10.81,75,,,fee schedule,75% of CMS fee schedule,10.81,75,,,fee schedule,75% of CMS fee schedule,14.41,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.4,40,,29.12,percent of total billed charges,40% of total billed charges,10.81,72.8,
CA 19-9,7000169,CDM,302,RC,86301,HCPCS,Outpatient,,,118,94.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,15.61,75,,,fee schedule,75% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,40,,37.76,percent of total billed charges,40% of total billed charges,15.61,94.4,
APOLIPOPROTEIN A-1,7000029,CDM,301,RC,82172,HCPCS,Outpatient,,,116,92.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,15.82,75,,,fee schedule,75% of CMS fee schedule,15.82,75,,,fee schedule,75% of CMS fee schedule,21.09,100,,,fee schedule,100% of CMS fee schedule,21.09,100,,,fee schedule,100% of CMS fee schedule,15.82,75,,,fee schedule,75% of CMS fee schedule,15.82,75,,,fee schedule,75% of CMS fee schedule,21.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,40,,37.12,percent of total billed charges,40% of total billed charges,15.82,92.8,
TOBRAMYCIN TROUGH,7000029,CDM,301,RC,80200,HCPCS,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,12.1,75,,,fee schedule,75% of CMS fee schedule,12.1,75,,,fee schedule,75% of CMS fee schedule,16.13,100,,,fee schedule,100% of CMS fee schedule,16.13,100,,,fee schedule,100% of CMS fee schedule,12.1,75,,,fee schedule,75% of CMS fee schedule,12.1,75,,,fee schedule,75% of CMS fee schedule,16.13,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,12.1,59.2,
PORPHYRIN SCREEN URI,7000029,CDM,301,RC,84119,HCPCS,Outpatient,,,120,96.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,10.02,75,,,fee schedule,75% of CMS fee schedule,10.02,75,,,fee schedule,75% of CMS fee schedule,13.36,100,,,fee schedule,100% of CMS fee schedule,13.36,100,,,fee schedule,100% of CMS fee schedule,10.02,75,,,fee schedule,75% of CMS fee schedule,10.02,75,,,fee schedule,75% of CMS fee schedule,13.36,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,40,,38.4,percent of total billed charges,40% of total billed charges,10.02,96,
ANDROSTENEDIONE,7000029,CDM,301,RC,82157,HCPCS,Outpatient,,,164,131.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,61.12,37.27,,48.9,percent of total billed charges,37.27% of total billed charges,61.12,37.27,,48.9,percent of total billed charges,37.27% of total billed charges,61.12,37.27,,48.9,percent of total billed charges,37.27% of total billed charges,21.96,75,,,fee schedule,75% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,40,,52.48,percent of total billed charges,40% of total billed charges,21.96,131.2,
DHEA-SULFATE,7000029,CDM,301,RC,82627,HCPCS,Outpatient,,,125,100.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100,80,,80,percent of total billed charges,80% of total billed charges,46.59,37.27,,37.27,percent of total billed charges,37.27% of total billed charges,46.59,37.27,,37.27,percent of total billed charges,37.27% of total billed charges,46.59,37.27,,37.27,percent of total billed charges,37.27% of total billed charges,16.67,75,,,fee schedule,75% of CMS fee schedule,16.67,75,,,fee schedule,75% of CMS fee schedule,22.23,100,,,fee schedule,100% of CMS fee schedule,22.23,100,,,fee schedule,100% of CMS fee schedule,16.67,75,,,fee schedule,75% of CMS fee schedule,16.67,75,,,fee schedule,75% of CMS fee schedule,22.23,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50,40,,40,percent of total billed charges,40% of total billed charges,16.67,100,
STOOL PH,7000029,CDM,301,RC,83986,HCPCS,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,2.69,75,,,fee schedule,75% of CMS fee schedule,2.69,75,,,fee schedule,75% of CMS fee schedule,3.58,100,,,fee schedule,100% of CMS fee schedule,3.58,100,,,fee schedule,100% of CMS fee schedule,2.69,75,,,fee schedule,75% of CMS fee schedule,2.69,75,,,fee schedule,75% of CMS fee schedule,3.58,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,2.69,16,
"ANTI-RNP,SM",7000169,CDM,302,RC,86235,HCPCS,Outpatient,,,127,101.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.8,40,,40.64,percent of total billed charges,40% of total billed charges,13.45,101.6,
"ANTI-SSA OR SSB, EAC",7000169,CDM,302,RC,86235,HCPCS,Outpatient,,,137,109.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,51.06,37.27,,40.85,percent of total billed charges,37.27% of total billed charges,51.06,37.27,,40.85,percent of total billed charges,37.27% of total billed charges,51.06,37.27,,40.85,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.8,40,,43.84,percent of total billed charges,40% of total billed charges,13.45,109.6,
ANTI-SCL-70,7000169,CDM,302,RC,86235,HCPCS,Outpatient,,,169,135.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,62.99,37.27,,50.39,percent of total billed charges,37.27% of total billed charges,62.99,37.27,,50.39,percent of total billed charges,37.27% of total billed charges,62.99,37.27,,50.39,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.6,40,,54.08,percent of total billed charges,40% of total billed charges,13.45,135.2,
"SENSITIVITY, AEROBIC",7000284,CDM,306,RC,87186,HCPCS,Outpatient,,,49,39.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,6.49,75,,,fee schedule,75% of CMS fee schedule,6.49,75,,,fee schedule,75% of CMS fee schedule,8.65,100,,,fee schedule,100% of CMS fee schedule,8.65,100,,,fee schedule,100% of CMS fee schedule,6.49,75,,,fee schedule,75% of CMS fee schedule,6.49,75,,,fee schedule,75% of CMS fee schedule,8.65,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,6.49,39.2,
"MYOGLOBIN, SERUM",7000029,CDM,301,RC,83874,HCPCS,Outpatient,,,158,126.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,58.89,37.27,,47.11,percent of total billed charges,37.27% of total billed charges,58.89,37.27,,47.11,percent of total billed charges,37.27% of total billed charges,58.89,37.27,,47.11,percent of total billed charges,37.27% of total billed charges,9.69,75,,,fee schedule,75% of CMS fee schedule,9.69,75,,,fee schedule,75% of CMS fee schedule,12.92,100,,,fee schedule,100% of CMS fee schedule,12.92,100,,,fee schedule,100% of CMS fee schedule,9.69,75,,,fee schedule,75% of CMS fee schedule,9.69,75,,,fee schedule,75% of CMS fee schedule,12.92,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.2,40,,50.56,percent of total billed charges,40% of total billed charges,9.69,126.4,
"MYOGLOBIN, URINE",7000029,CDM,301,RC,83874,HCPCS,Outpatient,,,158,126.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.4,80,,101.12,percent of total billed charges,80% of total billed charges,58.89,37.27,,47.11,percent of total billed charges,37.27% of total billed charges,58.89,37.27,,47.11,percent of total billed charges,37.27% of total billed charges,58.89,37.27,,47.11,percent of total billed charges,37.27% of total billed charges,9.69,75,,,fee schedule,75% of CMS fee schedule,9.69,75,,,fee schedule,75% of CMS fee schedule,12.92,100,,,fee schedule,100% of CMS fee schedule,12.92,100,,,fee schedule,100% of CMS fee schedule,9.69,75,,,fee schedule,75% of CMS fee schedule,9.69,75,,,fee schedule,75% of CMS fee schedule,12.92,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.2,40,,50.56,percent of total billed charges,40% of total billed charges,9.69,126.4,
ANTICENTROMERE ANTIB,7000169,CDM,302,RC,86255,HCPCS,Outpatient,,,97,77.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.8,40,,31.04,percent of total billed charges,40% of total billed charges,9.04,77.6,
"VIRUS CULTURE,",7000284,CDM,306,RC,87252,HCPCS,Outpatient,,,179,143.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,19.55,75,,,fee schedule,75% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.6,40,,57.28,percent of total billed charges,40% of total billed charges,19.55,143.2,
"AMINO ACID, PLASMA",7000029,CDM,301,RC,82131,HCPCS,Outpatient,,,340,272.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272,80,,217.6,percent of total billed charges,80% of total billed charges,126.72,37.27,,101.38,percent of total billed charges,37.27% of total billed charges,126.72,37.27,,101.38,percent of total billed charges,37.27% of total billed charges,126.72,37.27,,101.38,percent of total billed charges,37.27% of total billed charges,17.24,75,,,fee schedule,75% of CMS fee schedule,17.24,75,,,fee schedule,75% of CMS fee schedule,22.98,100,,,fee schedule,100% of CMS fee schedule,22.98,100,,,fee schedule,100% of CMS fee schedule,17.24,75,,,fee schedule,75% of CMS fee schedule,17.24,75,,,fee schedule,75% of CMS fee schedule,22.98,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136,40,,108.8,percent of total billed charges,40% of total billed charges,17.24,272,
CORDARONE,7000029,CDM,301,RC,82542,HCPCS,Outpatient,,,115,92.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,18.07,75,,,fee schedule,75% of CMS fee schedule,18.07,75,,,fee schedule,75% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,18.07,75,,,fee schedule,75% of CMS fee schedule,18.07,75,,,fee schedule,75% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46,40,,36.8,percent of total billed charges,40% of total billed charges,18.07,92,
IMMUNOGLOBULIN A,7000029,CDM,301,RC,82784,HCPCS,Outpatient,,,52,41.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,6.98,75,,,fee schedule,75% of CMS fee schedule,6.98,75,,,fee schedule,75% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,6.98,75,,,fee schedule,75% of CMS fee schedule,6.98,75,,,fee schedule,75% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,40,,16.64,percent of total billed charges,40% of total billed charges,6.98,41.6,
IMMUNOGLOBULIN G,7000029,CDM,301,RC,82784,HCPCS,Outpatient,,,52,41.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,6.98,75,,,fee schedule,75% of CMS fee schedule,6.98,75,,,fee schedule,75% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,6.98,75,,,fee schedule,75% of CMS fee schedule,6.98,75,,,fee schedule,75% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,40,,16.64,percent of total billed charges,40% of total billed charges,6.98,41.6,
IMMUNOGLOBULIN M,7000029,CDM,301,RC,82784,HCPCS,Outpatient,,,52,41.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,6.98,75,,,fee schedule,75% of CMS fee schedule,6.98,75,,,fee schedule,75% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,6.98,75,,,fee schedule,75% of CMS fee schedule,6.98,75,,,fee schedule,75% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,40,,16.64,percent of total billed charges,40% of total billed charges,6.98,41.6,
HETEROPHILE ANTIBODI,7000169,CDM,302,RC,86310,HCPCS,Outpatient,,,231,184.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% of total billed charges,5.53,75,,,fee schedule,75% of CMS fee schedule,5.53,75,,,fee schedule,75% of CMS fee schedule,7.37,100,,,fee schedule,100% of CMS fee schedule,7.37,100,,,fee schedule,100% of CMS fee schedule,5.53,75,,,fee schedule,75% of CMS fee schedule,5.53,75,,,fee schedule,75% of CMS fee schedule,7.37,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.4,40,,73.92,percent of total billed charges,40% of total billed charges,5.53,184.8,
"PLATELET ANTIBDY,DIR",7000169,CDM,302,RC,86022,HCPCS,Outpatient,,,305,244.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244,80,,195.2,percent of total billed charges,80% of total billed charges,113.67,37.27,,90.94,percent of total billed charges,37.27% of total billed charges,113.67,37.27,,90.94,percent of total billed charges,37.27% of total billed charges,113.67,37.27,,90.94,percent of total billed charges,37.27% of total billed charges,13.78,75,,,fee schedule,75% of CMS fee schedule,13.78,75,,,fee schedule,75% of CMS fee schedule,18.37,100,,,fee schedule,100% of CMS fee schedule,18.37,100,,,fee schedule,100% of CMS fee schedule,13.78,75,,,fee schedule,75% of CMS fee schedule,13.78,75,,,fee schedule,75% of CMS fee schedule,18.37,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122,40,,97.6,percent of total billed charges,40% of total billed charges,13.78,244,
MYCOPLASMA PNEUMONIA,7000169,CDM,302,RC,86738,HCPCS,Outpatient,,,197,157.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,9.93,75,,,fee schedule,75% of CMS fee schedule,9.93,75,,,fee schedule,75% of CMS fee schedule,13.24,100,,,fee schedule,100% of CMS fee schedule,13.24,100,,,fee schedule,100% of CMS fee schedule,9.93,75,,,fee schedule,75% of CMS fee schedule,9.93,75,,,fee schedule,75% of CMS fee schedule,13.24,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.8,40,,63.04,percent of total billed charges,40% of total billed charges,9.93,157.6,
CHLORIDE URINE 24 HO,7000029,CDM,301,RC,82436,HCPCS,Outpatient,,,29,23.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,4.31,75,,,fee schedule,75% of CMS fee schedule,4.31,75,,,fee schedule,75% of CMS fee schedule,5.75,100,,,fee schedule,100% of CMS fee schedule,5.75,100,,,fee schedule,100% of CMS fee schedule,4.31,75,,,fee schedule,75% of CMS fee schedule,4.31,75,,,fee schedule,75% of CMS fee schedule,5.75,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,4.31,23.2,
ACE,7000029,CDM,301,RC,82164,HCPCS,Outpatient,,,81,64.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,10.95,75,,,fee schedule,75% of CMS fee schedule,10.95,75,,,fee schedule,75% of CMS fee schedule,14.6,100,,,fee schedule,100% of CMS fee schedule,14.6,100,,,fee schedule,100% of CMS fee schedule,10.95,75,,,fee schedule,75% of CMS fee schedule,10.95,75,,,fee schedule,75% of CMS fee schedule,14.6,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,40,,25.92,percent of total billed charges,40% of total billed charges,10.95,64.8,
BETA-2 MICROGLOBULIN,7000029,CDM,301,RC,82232,HCPCS,Outpatient,,,91,72.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,12.14,75,,,fee schedule,75% of CMS fee schedule,12.14,75,,,fee schedule,75% of CMS fee schedule,16.18,100,,,fee schedule,100% of CMS fee schedule,16.18,100,,,fee schedule,100% of CMS fee schedule,12.14,75,,,fee schedule,75% of CMS fee schedule,12.14,75,,,fee schedule,75% of CMS fee schedule,16.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.4,40,,29.12,percent of total billed charges,40% of total billed charges,12.14,72.8,
T4/T8 RATIO,7000169,CDM,302,RC,86360,HCPCS,Outpatient,,,186,148.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,35.24,75,,,fee schedule,75% of CMS fee schedule,35.24,75,,,fee schedule,75% of CMS fee schedule,46.98,100,,,fee schedule,100% of CMS fee schedule,46.98,100,,,fee schedule,100% of CMS fee schedule,35.24,75,,,fee schedule,75% of CMS fee schedule,35.24,75,,,fee schedule,75% of CMS fee schedule,46.98,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,40,,59.52,percent of total billed charges,40% of total billed charges,35.24,148.8,
VANCOMYCIN PEAK,7000029,CDM,301,RC,80202,HCPCS,Outpatient,,,122,97.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,10.16,75,,,fee schedule,75% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.8,40,,39.04,percent of total billed charges,40% of total billed charges,10.16,97.6,
ANAEROBIC SENSITIVIT,7000284,CDM,306,RC,87186,HCPCS,Outpatient,,,56,44.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,6.49,75,,,fee schedule,75% of CMS fee schedule,6.49,75,,,fee schedule,75% of CMS fee schedule,8.65,100,,,fee schedule,100% of CMS fee schedule,8.65,100,,,fee schedule,100% of CMS fee schedule,6.49,75,,,fee schedule,75% of CMS fee schedule,6.49,75,,,fee schedule,75% of CMS fee schedule,8.65,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,40,,17.92,percent of total billed charges,40% of total billed charges,6.49,44.8,
APOLIPOPROTEIN B,7000029,CDM,301,RC,82172,HCPCS,Outpatient,,,116,92.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,15.82,75,,,fee schedule,75% of CMS fee schedule,15.82,75,,,fee schedule,75% of CMS fee schedule,21.09,100,,,fee schedule,100% of CMS fee schedule,21.09,100,,,fee schedule,100% of CMS fee schedule,15.82,75,,,fee schedule,75% of CMS fee schedule,15.82,75,,,fee schedule,75% of CMS fee schedule,21.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,40,,37.12,percent of total billed charges,40% of total billed charges,15.82,92.8,
VARICELLA ZOSTER IMM,7000169,CDM,302,RC,86787,HCPCS,Outpatient,,,76,60.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,40,,24.32,percent of total billed charges,40% of total billed charges,9.66,60.8,
VARICELLA ZOSTER ANT,7000169,CDM,302,RC,86787,HCPCS,Outpatient,,,76,60.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,40,,24.32,percent of total billed charges,40% of total billed charges,9.66,60.8,
ANTISMOOTH MUSCLE AB,7000169,CDM,302,RC,86015,HCPCS,Outpatient,,,67,53.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,9.04,53.6,
PROTEIN C ANTIGEN,7000177,CDM,305,RC,85302,HCPCS,Outpatient,,,218,174.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% of total billed charges,9.01,75,,,fee schedule,75% of CMS fee schedule,9.01,75,,,fee schedule,75% of CMS fee schedule,12.01,100,,,fee schedule,100% of CMS fee schedule,12.01,100,,,fee schedule,100% of CMS fee schedule,9.01,75,,,fee schedule,75% of CMS fee schedule,9.01,75,,,fee schedule,75% of CMS fee schedule,12.01,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.2,40,,69.76,percent of total billed charges,40% of total billed charges,9.01,174.4,
PROTEIN S ANTIGEN,7000177,CDM,305,RC,85305,HCPCS,Outpatient,,,259,207.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,96.53,37.27,,77.22,percent of total billed charges,37.27% of total billed charges,96.53,37.27,,77.22,percent of total billed charges,37.27% of total billed charges,96.53,37.27,,77.22,percent of total billed charges,37.27% of total billed charges,8.71,75,,,fee schedule,75% of CMS fee schedule,8.71,75,,,fee schedule,75% of CMS fee schedule,11.61,100,,,fee schedule,100% of CMS fee schedule,11.61,100,,,fee schedule,100% of CMS fee schedule,8.71,75,,,fee schedule,75% of CMS fee schedule,8.71,75,,,fee schedule,75% of CMS fee schedule,11.61,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.6,40,,82.88,percent of total billed charges,40% of total billed charges,8.71,207.2,
"PARAINFLUENZA 1,2,3",7000169,CDM,302,RC,86710,HCPCS,Outpatient,,,200,160.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160,80,,128,percent of total billed charges,80% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,10.16,75,,,fee schedule,75% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,13.55,100,,,fee schedule,100% of CMS fee schedule,13.55,100,,,fee schedule,100% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,13.55,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,40,,64,percent of total billed charges,40% of total billed charges,10.16,160,
CA 125,7000169,CDM,302,RC,86304,HCPCS,Outpatient,,,126,100.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,15.61,75,,,fee schedule,75% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,40,,40.32,percent of total billed charges,40% of total billed charges,15.61,100.8,
17 HYDROXYPROGESTERO,7000029,CDM,301,RC,83498,HCPCS,Outpatient,,,153,122.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,57.02,37.27,,45.62,percent of total billed charges,37.27% of total billed charges,57.02,37.27,,45.62,percent of total billed charges,37.27% of total billed charges,57.02,37.27,,45.62,percent of total billed charges,37.27% of total billed charges,20.38,75,,,fee schedule,75% of CMS fee schedule,20.38,75,,,fee schedule,75% of CMS fee schedule,27.17,100,,,fee schedule,100% of CMS fee schedule,27.17,100,,,fee schedule,100% of CMS fee schedule,20.38,75,,,fee schedule,75% of CMS fee schedule,20.38,75,,,fee schedule,75% of CMS fee schedule,27.17,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.2,40,,48.96,percent of total billed charges,40% of total billed charges,20.38,122.4,
RMSF IGG,7000169,CDM,302,RC,86256,HCPCS,Outpatient,,,57.86,46.29,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.29,80,,37.03,percent of total billed charges,80% of total billed charges,21.56,37.27,,17.25,percent of total billed charges,37.27% of total billed charges,21.56,37.27,,17.25,percent of total billed charges,37.27% of total billed charges,21.56,37.27,,17.25,percent of total billed charges,37.27% of total billed charges,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.14,40,,18.51,percent of total billed charges,40% of total billed charges,9.04,46.29,
"RUBEOLA IGG, IMMUNIT",7000169,CDM,302,RC,86765,HCPCS,Outpatient,,,76,60.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,40,,24.32,percent of total billed charges,40% of total billed charges,9.66,60.8,
PARVOVIRUS B19 IGG,7000169,CDM,302,RC,86747,HCPCS,Outpatient,,,113,90.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,11.27,75,,,fee schedule,75% of CMS fee schedule,11.27,75,,,fee schedule,75% of CMS fee schedule,15.03,100,,,fee schedule,100% of CMS fee schedule,15.03,100,,,fee schedule,100% of CMS fee schedule,11.27,75,,,fee schedule,75% of CMS fee schedule,11.27,75,,,fee schedule,75% of CMS fee schedule,15.03,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.2,40,,36.16,percent of total billed charges,40% of total billed charges,11.27,90.4,
UREA NITROGEN-URINE,7000029,CDM,301,RC,84540,HCPCS,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,4.17,75,,,fee schedule,75% of CMS fee schedule,4.17,75,,,fee schedule,75% of CMS fee schedule,5.56,100,,,fee schedule,100% of CMS fee schedule,5.56,100,,,fee schedule,100% of CMS fee schedule,4.17,75,,,fee schedule,75% of CMS fee schedule,4.17,75,,,fee schedule,75% of CMS fee schedule,5.56,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,40,,16,percent of total billed charges,40% of total billed charges,4.17,40,
ERYTHROPOIETIN,7000029,CDM,301,RC,82668,HCPCS,Outpatient,,,151,120.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% of total billed charges,14.09,75,,,fee schedule,75% of CMS fee schedule,14.09,75,,,fee schedule,75% of CMS fee schedule,18.79,100,,,fee schedule,100% of CMS fee schedule,18.79,100,,,fee schedule,100% of CMS fee schedule,14.09,75,,,fee schedule,75% of CMS fee schedule,14.09,75,,,fee schedule,75% of CMS fee schedule,18.79,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.4,40,,48.32,percent of total billed charges,40% of total billed charges,14.09,120.8,
IMMUNOFIXATION SERUM,7000169,CDM,302,RC,86325,HCPCS,Outpatient,,,126,100.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,17.35,75,,,fee schedule,75% of CMS fee schedule,17.35,75,,,fee schedule,75% of CMS fee schedule,23.13,100,,,fee schedule,100% of CMS fee schedule,23.13,100,,,fee schedule,100% of CMS fee schedule,17.35,75,,,fee schedule,75% of CMS fee schedule,17.35,75,,,fee schedule,75% of CMS fee schedule,23.13,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,40,,40.32,percent of total billed charges,40% of total billed charges,17.35,100.8,
ANTIDIURETIC HORMONE,7000029,CDM,301,RC,84588,HCPCS,Outpatient,,,279,223.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,103.98,37.27,,83.18,percent of total billed charges,37.27% of total billed charges,103.98,37.27,,83.18,percent of total billed charges,37.27% of total billed charges,103.98,37.27,,83.18,percent of total billed charges,37.27% of total billed charges,25.46,75,,,fee schedule,75% of CMS fee schedule,25.46,75,,,fee schedule,75% of CMS fee schedule,33.94,100,,,fee schedule,100% of CMS fee schedule,33.94,100,,,fee schedule,100% of CMS fee schedule,25.46,75,,,fee schedule,75% of CMS fee schedule,25.46,75,,,fee schedule,75% of CMS fee schedule,33.94,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.6,40,,89.28,percent of total billed charges,40% of total billed charges,25.46,223.2,
"VITAMIN D, 25 HYDROX",7000029,CDM,301,RC,82306,HCPCS,Outpatient,,,216,172.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,80.5,37.27,,64.4,percent of total billed charges,37.27% of total billed charges,80.5,37.27,,64.4,percent of total billed charges,37.27% of total billed charges,80.5,37.27,,64.4,percent of total billed charges,37.27% of total billed charges,22.2,75,,,fee schedule,75% of CMS fee schedule,22.2,75,,,fee schedule,75% of CMS fee schedule,29.6,100,,,fee schedule,100% of CMS fee schedule,29.6,100,,,fee schedule,100% of CMS fee schedule,22.2,75,,,fee schedule,75% of CMS fee schedule,22.2,75,,,fee schedule,75% of CMS fee schedule,29.6,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,40,,69.12,percent of total billed charges,40% of total billed charges,22.2,172.8,
ROTOVIRUS ANTIGEN,7000284,CDM,306,RC,87425,HCPCS,Outpatient,,,83,66.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,8.99,75,,,fee schedule,75% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.2,40,,26.56,percent of total billed charges,40% of total billed charges,8.99,66.4,
FACTOR VII,7000177,CDM,305,RC,85230,HCPCS,Outpatient,,,182,145.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% of total billed charges,13.43,75,,,fee schedule,75% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.8,40,,58.24,percent of total billed charges,40% of total billed charges,13.43,145.6,
FACTOR VIII,7000177,CDM,305,RC,85240,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,13.43,75,,,fee schedule,75% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,13.43,128,
LDL CHOLESTEROL,7000029,CDM,301,RC,83721,HCPCS,Outpatient,,,83,66.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,7.88,75,,,fee schedule,75% of CMS fee schedule,7.88,75,,,fee schedule,75% of CMS fee schedule,10.5,100,,,fee schedule,100% of CMS fee schedule,10.5,100,,,fee schedule,100% of CMS fee schedule,7.88,75,,,fee schedule,75% of CMS fee schedule,7.88,75,,,fee schedule,75% of CMS fee schedule,10.5,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.2,40,,26.56,percent of total billed charges,40% of total billed charges,7.88,66.4,
C-1 ESTERASE INHIBIT,7000169,CDM,302,RC,86161,HCPCS,Outpatient,,,112,89.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,9,75,,,fee schedule,75% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,40,,35.84,percent of total billed charges,40% of total billed charges,9,89.6,
HEPATITIS C ANTIBODY,7000169,CDM,302,RC,86803,HCPCS,Outpatient,,,111,88.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% of total billed charges,10.7,75,,,fee schedule,75% of CMS fee schedule,10.7,75,,,fee schedule,75% of CMS fee schedule,14.27,100,,,fee schedule,100% of CMS fee schedule,14.27,100,,,fee schedule,100% of CMS fee schedule,10.7,75,,,fee schedule,75% of CMS fee schedule,10.7,75,,,fee schedule,75% of CMS fee schedule,14.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,40,,35.52,percent of total billed charges,40% of total billed charges,10.7,88.8,
PROTEIN ELECTROPH UR,7000029,CDM,301,RC,84166,HCPCS,Outpatient,,,90,72.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,13.37,75,,,fee schedule,75% of CMS fee schedule,13.37,75,,,fee schedule,75% of CMS fee schedule,17.83,100,,,fee schedule,100% of CMS fee schedule,17.83,100,,,fee schedule,100% of CMS fee schedule,13.37,75,,,fee schedule,75% of CMS fee schedule,13.37,75,,,fee schedule,75% of CMS fee schedule,17.83,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,40,,28.8,percent of total billed charges,40% of total billed charges,13.37,72,
TACROLIMUS (FK506),7000029,CDM,301,RC,80197,HCPCS,Outpatient,,,113,90.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,10.3,75,,,fee schedule,75% of CMS fee schedule,10.3,75,,,fee schedule,75% of CMS fee schedule,13.73,100,,,fee schedule,100% of CMS fee schedule,13.73,100,,,fee schedule,100% of CMS fee schedule,10.3,75,,,fee schedule,75% of CMS fee schedule,10.3,75,,,fee schedule,75% of CMS fee schedule,13.73,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.2,40,,36.16,percent of total billed charges,40% of total billed charges,10.3,90.4,
ANAEROBIC CULTURE,7000284,CDM,306,RC,87075,HCPCS,Outpatient,,,95,76.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,7.1,75,,,fee schedule,75% of CMS fee schedule,7.1,75,,,fee schedule,75% of CMS fee schedule,9.47,100,,,fee schedule,100% of CMS fee schedule,9.47,100,,,fee schedule,100% of CMS fee schedule,7.1,75,,,fee schedule,75% of CMS fee schedule,7.1,75,,,fee schedule,75% of CMS fee schedule,9.47,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38,40,,30.4,percent of total billed charges,40% of total billed charges,7.1,76,
PLASMINOGEN,7000177,CDM,305,RC,85420,HCPCS,Outpatient,,,133,106.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,4.9,75,,,fee schedule,75% of CMS fee schedule,4.9,75,,,fee schedule,75% of CMS fee schedule,6.53,100,,,fee schedule,100% of CMS fee schedule,6.53,100,,,fee schedule,100% of CMS fee schedule,4.9,75,,,fee schedule,75% of CMS fee schedule,4.9,75,,,fee schedule,75% of CMS fee schedule,6.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.2,40,,42.56,percent of total billed charges,40% of total billed charges,4.9,106.4,
PLATELET ACTIVATOR H,7000177,CDM,305,RC,85415,HCPCS,Outpatient,,,328,262.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,122.25,37.27,,97.8,percent of total billed charges,37.27% of total billed charges,122.25,37.27,,97.8,percent of total billed charges,37.27% of total billed charges,122.25,37.27,,97.8,percent of total billed charges,37.27% of total billed charges,12.89,75,,,fee schedule,75% of CMS fee schedule,12.89,75,,,fee schedule,75% of CMS fee schedule,17.19,100,,,fee schedule,100% of CMS fee schedule,17.19,100,,,fee schedule,100% of CMS fee schedule,12.89,75,,,fee schedule,75% of CMS fee schedule,12.89,75,,,fee schedule,75% of CMS fee schedule,17.19,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.2,40,,104.96,percent of total billed charges,40% of total billed charges,12.89,262.4,
"CALCIUM, IONIZED",7000029,CDM,301,RC,82330,HCPCS,Outpatient,,,92,73.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,10.26,75,,,fee schedule,75% of CMS fee schedule,10.26,75,,,fee schedule,75% of CMS fee schedule,13.68,100,,,fee schedule,100% of CMS fee schedule,13.68,100,,,fee schedule,100% of CMS fee schedule,10.26,75,,,fee schedule,75% of CMS fee schedule,10.26,75,,,fee schedule,75% of CMS fee schedule,13.68,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,40,,29.44,percent of total billed charges,40% of total billed charges,10.26,73.6,
SIROLIMUS,7000029,CDM,301,RC,80195,HCPCS,Outpatient,,,113,90.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,10.3,75,,,fee schedule,75% of CMS fee schedule,10.3,75,,,fee schedule,75% of CMS fee schedule,13.73,100,,,fee schedule,100% of CMS fee schedule,13.73,100,,,fee schedule,100% of CMS fee schedule,10.3,75,,,fee schedule,75% of CMS fee schedule,10.3,75,,,fee schedule,75% of CMS fee schedule,13.73,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.2,40,,36.16,percent of total billed charges,40% of total billed charges,10.3,90.4,
C-PEPTIDE,7000029,CDM,301,RC,84681,HCPCS,Outpatient,,,118,94.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,15.61,75,,,fee schedule,75% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,40,,37.76,percent of total billed charges,40% of total billed charges,15.61,94.4,
"MERCURY LEVEL,BLD/UR",7000029,CDM,301,RC,83825,HCPCS,Outpatient,,,91,72.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,12.2,75,,,fee schedule,75% of CMS fee schedule,12.2,75,,,fee schedule,75% of CMS fee schedule,16.26,100,,,fee schedule,100% of CMS fee schedule,16.26,100,,,fee schedule,100% of CMS fee schedule,12.2,75,,,fee schedule,75% of CMS fee schedule,12.2,75,,,fee schedule,75% of CMS fee schedule,16.26,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.4,40,,29.12,percent of total billed charges,40% of total billed charges,12.2,72.8,
ACHR BLOCKING ANTIB,7000029,CDM,301,RC,83519,HCPCS,Outpatient,,,265,212.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,212,80,,169.6,percent of total billed charges,80% of total billed charges,98.77,37.27,,79.02,percent of total billed charges,37.27% of total billed charges,98.77,37.27,,79.02,percent of total billed charges,37.27% of total billed charges,98.77,37.27,,79.02,percent of total billed charges,37.27% of total billed charges,13.8,75,,,fee schedule,75% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106,40,,84.8,percent of total billed charges,40% of total billed charges,13.8,212,
ACHR BINDING ANTIB,7000029,CDM,301,RC,83519,HCPCS,Outpatient,,,204,163.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% of total billed charges,13.8,75,,,fee schedule,75% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,40,,65.28,percent of total billed charges,40% of total billed charges,13.8,163.2,
RPR,7000169,CDM,302,RC,86592,HCPCS,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,3.2,19.2,
URINALYSIS W/O MICRO,7018237,CDM,307,RC,81003,HCPCS,Outpatient,,,14,11.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,1.69,75,,,fee schedule,75% of CMS fee schedule,1.69,75,,,fee schedule,75% of CMS fee schedule,2.25,100,,,fee schedule,100% of CMS fee schedule,2.25,100,,,fee schedule,100% of CMS fee schedule,1.69,75,,,fee schedule,75% of CMS fee schedule,1.69,75,,,fee schedule,75% of CMS fee schedule,2.25,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,1.69,11.2,
HERPES SIMPLEX 1/2 P,7000284,CDM,306,RC,87529,HCPCS,Outpatient,,,413,330.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165.2,40,,132.16,percent of total billed charges,40% of total billed charges,26.32,330.4,
FUNGUS ID,7000284,CDM,306,RC,87106,HCPCS,Outpatient,,,94,75.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,7.74,75,,,fee schedule,75% of CMS fee schedule,7.74,75,,,fee schedule,75% of CMS fee schedule,10.32,100,,,fee schedule,100% of CMS fee schedule,10.32,100,,,fee schedule,100% of CMS fee schedule,7.74,75,,,fee schedule,75% of CMS fee schedule,7.74,75,,,fee schedule,75% of CMS fee schedule,10.32,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,7.74,75.2,
T3 FREE,7000029,CDM,301,RC,84481,HCPCS,Outpatient,,,133,106.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,12.71,75,,,fee schedule,75% of CMS fee schedule,12.71,75,,,fee schedule,75% of CMS fee schedule,16.94,100,,,fee schedule,100% of CMS fee schedule,16.94,100,,,fee schedule,100% of CMS fee schedule,12.71,75,,,fee schedule,75% of CMS fee schedule,12.71,75,,,fee schedule,75% of CMS fee schedule,16.94,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.2,40,,42.56,percent of total billed charges,40% of total billed charges,12.71,106.4,
ANTICARDIOLIPIN ANTI,7000169,CDM,302,RC,86147,HCPCS,Outpatient,,,105,84.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,19.09,75,,,fee schedule,75% of CMS fee schedule,19.09,75,,,fee schedule,75% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,19.09,75,,,fee schedule,75% of CMS fee schedule,19.09,75,,,fee schedule,75% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,40,,33.6,percent of total billed charges,40% of total billed charges,19.09,84,
GASTRIC PH,7000029,CDM,301,RC,83986,HCPCS,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,2.69,75,,,fee schedule,75% of CMS fee schedule,2.69,75,,,fee schedule,75% of CMS fee schedule,3.58,100,,,fee schedule,100% of CMS fee schedule,3.58,100,,,fee schedule,100% of CMS fee schedule,2.69,75,,,fee schedule,75% of CMS fee schedule,2.69,75,,,fee schedule,75% of CMS fee schedule,3.58,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,2.69,31.2,
ANABOLIC STEROIDS,7000029,CDM,301,RC,82157,HCPCS,Outpatient,,,204,163.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% of total billed charges,21.96,75,,,fee schedule,75% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,40,,65.28,percent of total billed charges,40% of total billed charges,21.96,163.2,
E COLI TYPING,7000284,CDM,306,RC,87147,HCPCS,Outpatient,,,63,50.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,3.89,75,,,fee schedule,75% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,40,,20.16,percent of total billed charges,40% of total billed charges,3.89,50.4,
DHEA,7000029,CDM,301,RC,82626,HCPCS,Outpatient,,,141,112.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.8,80,,90.24,percent of total billed charges,80% of total billed charges,52.55,37.27,,42.04,percent of total billed charges,37.27% of total billed charges,52.55,37.27,,42.04,percent of total billed charges,37.27% of total billed charges,52.55,37.27,,42.04,percent of total billed charges,37.27% of total billed charges,18.95,75,,,fee schedule,75% of CMS fee schedule,18.95,75,,,fee schedule,75% of CMS fee schedule,25.27,100,,,fee schedule,100% of CMS fee schedule,25.27,100,,,fee schedule,100% of CMS fee schedule,18.95,75,,,fee schedule,75% of CMS fee schedule,18.95,75,,,fee schedule,75% of CMS fee schedule,25.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.4,40,,45.12,percent of total billed charges,40% of total billed charges,18.95,112.8,
RESPIRATORY SYNCYTIA,7000284,CDM,306,RC,87807,HCPCS,Outpatient,,,83,66.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,9.83,75,,,fee schedule,75% of CMS fee schedule,9.83,75,,,fee schedule,75% of CMS fee schedule,13.1,100,,,fee schedule,100% of CMS fee schedule,13.1,100,,,fee schedule,100% of CMS fee schedule,9.83,75,,,fee schedule,75% of CMS fee schedule,9.83,75,,,fee schedule,75% of CMS fee schedule,13.1,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.2,40,,26.56,percent of total billed charges,40% of total billed charges,9.83,66.4,
ALPHA FETO-PRO TUMOR,7000029,CDM,301,RC,82105,HCPCS,Outpatient,,,94,75.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,12.58,75,,,fee schedule,75% of CMS fee schedule,12.58,75,,,fee schedule,75% of CMS fee schedule,16.77,100,,,fee schedule,100% of CMS fee schedule,16.77,100,,,fee schedule,100% of CMS fee schedule,12.58,75,,,fee schedule,75% of CMS fee schedule,12.58,75,,,fee schedule,75% of CMS fee schedule,16.77,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,12.58,75.2,
VON WILLEBRAND ANTIG,7000177,CDM,305,RC,85246,HCPCS,Outpatient,,,246,196.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,91.68,37.27,,73.34,percent of total billed charges,37.27% of total billed charges,91.68,37.27,,73.34,percent of total billed charges,37.27% of total billed charges,91.68,37.27,,73.34,percent of total billed charges,37.27% of total billed charges,17.21,75,,,fee schedule,75% of CMS fee schedule,17.21,75,,,fee schedule,75% of CMS fee schedule,22.94,100,,,fee schedule,100% of CMS fee schedule,22.94,100,,,fee schedule,100% of CMS fee schedule,17.21,75,,,fee schedule,75% of CMS fee schedule,17.21,75,,,fee schedule,75% of CMS fee schedule,22.94,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,40,,78.72,percent of total billed charges,40% of total billed charges,17.21,196.8,
CHLAMYDIA AB IGG IGM,7000169,CDM,302,RC,86631,HCPCS,Outpatient,,,169,135.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,62.99,37.27,,50.39,percent of total billed charges,37.27% of total billed charges,62.99,37.27,,50.39,percent of total billed charges,37.27% of total billed charges,62.99,37.27,,50.39,percent of total billed charges,37.27% of total billed charges,8.87,75,,,fee schedule,75% of CMS fee schedule,8.87,75,,,fee schedule,75% of CMS fee schedule,11.82,100,,,fee schedule,100% of CMS fee schedule,11.82,100,,,fee schedule,100% of CMS fee schedule,8.87,75,,,fee schedule,75% of CMS fee schedule,8.87,75,,,fee schedule,75% of CMS fee schedule,11.82,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.6,40,,54.08,percent of total billed charges,40% of total billed charges,8.87,135.2,
SPECIFIC GRAVITY FLU,7000029,CDM,301,RC,84315,HCPCS,Outpatient,,,14,11.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,2.46,11.2,
ALIMINUM,7000029,CDM,301,RC,82108,HCPCS,Outpatient,,,126,100.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,19.11,75,,,fee schedule,75% of CMS fee schedule,19.11,75,,,fee schedule,75% of CMS fee schedule,25.48,100,,,fee schedule,100% of CMS fee schedule,25.48,100,,,fee schedule,100% of CMS fee schedule,19.11,75,,,fee schedule,75% of CMS fee schedule,19.11,75,,,fee schedule,75% of CMS fee schedule,25.48,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,40,,40.32,percent of total billed charges,40% of total billed charges,19.11,100.8,
ANTI-NEUTROPHIL CYTO,7000169,CDM,302,RC,86256,HCPCS,Outpatient,,,57.86,46.29,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.29,80,,37.03,percent of total billed charges,80% of total billed charges,21.56,37.27,,17.25,percent of total billed charges,37.27% of total billed charges,21.56,37.27,,17.25,percent of total billed charges,37.27% of total billed charges,21.56,37.27,,17.25,percent of total billed charges,37.27% of total billed charges,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.14,40,,18.51,percent of total billed charges,40% of total billed charges,9.04,46.29,
P ANCA,7000169,CDM,302,RC,86021,HCPCS,Outpatient,,,199,159.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,11.29,75,,,fee schedule,75% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.6,40,,63.68,percent of total billed charges,40% of total billed charges,11.29,159.2,
PNEUMOCOCCAL VAC RES,7000169,CDM,302,RC,86609,HCPCS,Outpatient,,,73,58.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,9.66,58.4,
CMV DNA QUANTITATIVE,7000284,CDM,306,RC,87497,HCPCS,Outpatient,,,385,308.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308,80,,246.4,percent of total billed charges,80% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,32.13,75,,,fee schedule,75% of CMS fee schedule,32.13,75,,,fee schedule,75% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,32.13,75,,,fee schedule,75% of CMS fee schedule,32.13,75,,,fee schedule,75% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154,40,,123.2,percent of total billed charges,40% of total billed charges,32.13,308,
VENIPUNCTURE,7012032,CDM,300,RC,36415,HCPCS,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,6.62,20,
KOH PREP,7000284,CDM,306,RC,87205,HCPCS,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,3.2,20,
AMYLASE FLUID,7000029,CDM,301,RC,82150,HCPCS,Outpatient,,,36,28.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,4.86,75,,,fee schedule,75% of CMS fee schedule,4.86,75,,,fee schedule,75% of CMS fee schedule,6.48,100,,,fee schedule,100% of CMS fee schedule,6.48,100,,,fee schedule,100% of CMS fee schedule,4.86,75,,,fee schedule,75% of CMS fee schedule,4.86,75,,,fee schedule,75% of CMS fee schedule,6.48,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,4.86,28.8,
LDH FLUID,7000029,CDM,301,RC,83625,HCPCS,Outpatient,,,52,41.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,9.59,75,,,fee schedule,75% of CMS fee schedule,9.59,75,,,fee schedule,75% of CMS fee schedule,12.79,100,,,fee schedule,100% of CMS fee schedule,12.79,100,,,fee schedule,100% of CMS fee schedule,9.59,75,,,fee schedule,75% of CMS fee schedule,9.59,75,,,fee schedule,75% of CMS fee schedule,12.79,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,40,,16.64,percent of total billed charges,40% of total billed charges,9.59,41.6,
PROTEIN FLUID,7000029,CDM,301,RC,84157,HCPCS,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,3,75,,,fee schedule,75% of CMS fee schedule,3,75,,,fee schedule,75% of CMS fee schedule,4,100,,,fee schedule,100% of CMS fee schedule,4,100,,,fee schedule,100% of CMS fee schedule,3,75,,,fee schedule,75% of CMS fee schedule,3,75,,,fee schedule,75% of CMS fee schedule,4,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,3,21.6,
GLUCOSE FLUID,7000029,CDM,301,RC,82945,HCPCS,Outpatient,,,21,16.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,2.95,75,,,fee schedule,75% of CMS fee schedule,2.95,75,,,fee schedule,75% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,2.95,75,,,fee schedule,75% of CMS fee schedule,2.95,75,,,fee schedule,75% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,2.95,16.8,
"OCCULT BLOOD, PH, GA",7000029,CDM,301,RC,82271,HCPCS,Outpatient,,,27,21.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,3.99,75,,,fee schedule,75% of CMS fee schedule,3.99,75,,,fee schedule,75% of CMS fee schedule,5.32,100,,,fee schedule,100% of CMS fee schedule,5.32,100,,,fee schedule,100% of CMS fee schedule,3.99,75,,,fee schedule,75% of CMS fee schedule,3.99,75,,,fee schedule,75% of CMS fee schedule,5.32,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,3.99,21.6,
ENDOMYSIAL ANTIBODY,7000169,CDM,302,RC,86231,HCPCS,Outpatient,,,199,159.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,9.07,75,,,fee schedule,75% of CMS fee schedule,9.07,75,,,fee schedule,75% of CMS fee schedule,12.09,100,,,fee schedule,100% of CMS fee schedule,12.09,100,,,fee schedule,100% of CMS fee schedule,9.07,75,,,fee schedule,75% of CMS fee schedule,9.07,75,,,fee schedule,75% of CMS fee schedule,12.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.6,40,,63.68,percent of total billed charges,40% of total billed charges,9.07,159.2,
IMMUN INF AGT ANTIBO,7000169,CDM,302,RC,86317,HCPCS,Outpatient,,,71.4,57.12,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.12,80,,45.7,percent of total billed charges,80% of total billed charges,26.61,37.27,,21.29,percent of total billed charges,37.27% of total billed charges,26.61,37.27,,21.29,percent of total billed charges,37.27% of total billed charges,26.61,37.27,,21.29,percent of total billed charges,37.27% of total billed charges,11.24,75,,,fee schedule,75% of CMS fee schedule,11.24,75,,,fee schedule,75% of CMS fee schedule,14.99,100,,,fee schedule,100% of CMS fee schedule,14.99,100,,,fee schedule,100% of CMS fee schedule,11.24,75,,,fee schedule,75% of CMS fee schedule,11.24,75,,,fee schedule,75% of CMS fee schedule,14.99,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.56,40,,22.85,percent of total billed charges,40% of total billed charges,11.24,57.12,
"VON WILL.ANTIG.,MULT",7000177,CDM,305,RC,85247,HCPCS,Outpatient,,,267,213.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,213.6,80,,170.88,percent of total billed charges,80% of total billed charges,99.51,37.27,,79.61,percent of total billed charges,37.27% of total billed charges,99.51,37.27,,79.61,percent of total billed charges,37.27% of total billed charges,99.51,37.27,,79.61,percent of total billed charges,37.27% of total billed charges,17.21,75,,,fee schedule,75% of CMS fee schedule,17.21,75,,,fee schedule,75% of CMS fee schedule,22.94,100,,,fee schedule,100% of CMS fee schedule,22.94,100,,,fee schedule,100% of CMS fee schedule,17.21,75,,,fee schedule,75% of CMS fee schedule,17.21,75,,,fee schedule,75% of CMS fee schedule,22.94,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.8,40,,85.44,percent of total billed charges,40% of total billed charges,17.21,213.6,
"ALBUMIN,MCROALBMN,UR",7000029,CDM,301,RC,82043,HCPCS,Outpatient,,,41,32.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,4.34,75,,,fee schedule,75% of CMS fee schedule,4.34,75,,,fee schedule,75% of CMS fee schedule,5.78,100,,,fee schedule,100% of CMS fee schedule,5.78,100,,,fee schedule,100% of CMS fee schedule,4.34,75,,,fee schedule,75% of CMS fee schedule,4.34,75,,,fee schedule,75% of CMS fee schedule,5.78,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,4.34,32.8,
ANTI-PARIETAL CELL,7000169,CDM,302,RC,83516,HCPCS,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28,40,,22.4,percent of total billed charges,40% of total billed charges,8.65,56,
ANTI-INTRINISIC FACT,7000169,CDM,302,RC,86340,HCPCS,Outpatient,,,119,95.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,11.31,75,,,fee schedule,75% of CMS fee schedule,11.31,75,,,fee schedule,75% of CMS fee schedule,15.08,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of CMS fee schedule,11.31,75,,,fee schedule,75% of CMS fee schedule,11.31,75,,,fee schedule,75% of CMS fee schedule,15.08,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.6,40,,38.08,percent of total billed charges,40% of total billed charges,11.31,95.2,
"HEAVY METAL, PLASMA",7000029,CDM,301,RC,83015,HCPCS,Outpatient,,,139,111.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,51.81,37.27,,41.45,percent of total billed charges,37.27% of total billed charges,51.81,37.27,,41.45,percent of total billed charges,37.27% of total billed charges,51.81,37.27,,41.45,percent of total billed charges,37.27% of total billed charges,15.71,75,,,fee schedule,75% of CMS fee schedule,15.71,75,,,fee schedule,75% of CMS fee schedule,20.94,100,,,fee schedule,100% of CMS fee schedule,20.94,100,,,fee schedule,100% of CMS fee schedule,15.71,75,,,fee schedule,75% of CMS fee schedule,15.71,75,,,fee schedule,75% of CMS fee schedule,20.94,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.6,40,,44.48,percent of total billed charges,40% of total billed charges,15.71,111.2,
OSMOLALITY URINE,7000029,CDM,301,RC,83935,HCPCS,Outpatient,,,46,36.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,5.12,75,,,fee schedule,75% of CMS fee schedule,5.12,75,,,fee schedule,75% of CMS fee schedule,6.82,100,,,fee schedule,100% of CMS fee schedule,6.82,100,,,fee schedule,100% of CMS fee schedule,5.12,75,,,fee schedule,75% of CMS fee schedule,5.12,75,,,fee schedule,75% of CMS fee schedule,6.82,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,5.12,36.8,
STREP B SCREEN,7000284,CDM,306,RC,87081,HCPCS,Outpatient,,,38,30.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,4.97,75,,,fee schedule,75% of CMS fee schedule,4.97,75,,,fee schedule,75% of CMS fee schedule,6.63,100,,,fee schedule,100% of CMS fee schedule,6.63,100,,,fee schedule,100% of CMS fee schedule,4.97,75,,,fee schedule,75% of CMS fee schedule,4.97,75,,,fee schedule,75% of CMS fee schedule,6.63,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,4.97,30.4,
CALCITONIN,7000029,CDM,301,RC,82308,HCPCS,Outpatient,,,150,120.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,20.09,75,,,fee schedule,75% of CMS fee schedule,20.09,75,,,fee schedule,75% of CMS fee schedule,26.79,100,,,fee schedule,100% of CMS fee schedule,26.79,100,,,fee schedule,100% of CMS fee schedule,20.09,75,,,fee schedule,75% of CMS fee schedule,20.09,75,,,fee schedule,75% of CMS fee schedule,26.79,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,40,,48,percent of total billed charges,40% of total billed charges,20.09,120,
RAJI CELL ASSAY,7000169,CDM,302,RC,86332,HCPCS,Outpatient,,,161,128.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% of total billed charges,18.28,75,,,fee schedule,75% of CMS fee schedule,18.28,75,,,fee schedule,75% of CMS fee schedule,24.37,100,,,fee schedule,100% of CMS fee schedule,24.37,100,,,fee schedule,100% of CMS fee schedule,18.28,75,,,fee schedule,75% of CMS fee schedule,18.28,75,,,fee schedule,75% of CMS fee schedule,24.37,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.4,40,,51.52,percent of total billed charges,40% of total billed charges,18.28,128.8,
C1Q-BINDING,7000169,CDM,302,RC,86332,HCPCS,Outpatient,,,137,109.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,51.06,37.27,,40.85,percent of total billed charges,37.27% of total billed charges,51.06,37.27,,40.85,percent of total billed charges,37.27% of total billed charges,51.06,37.27,,40.85,percent of total billed charges,37.27% of total billed charges,18.28,75,,,fee schedule,75% of CMS fee schedule,18.28,75,,,fee schedule,75% of CMS fee schedule,24.37,100,,,fee schedule,100% of CMS fee schedule,24.37,100,,,fee schedule,100% of CMS fee schedule,18.28,75,,,fee schedule,75% of CMS fee schedule,18.28,75,,,fee schedule,75% of CMS fee schedule,24.37,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.8,40,,43.84,percent of total billed charges,40% of total billed charges,18.28,109.6,
TROPONIN,7000029,CDM,301,RC,84484,HCPCS,Outpatient,,,63,50.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,9.35,75,,,fee schedule,75% of CMS fee schedule,9.35,75,,,fee schedule,75% of CMS fee schedule,12.47,100,,,fee schedule,100% of CMS fee schedule,12.47,100,,,fee schedule,100% of CMS fee schedule,9.35,75,,,fee schedule,75% of CMS fee schedule,9.35,75,,,fee schedule,75% of CMS fee schedule,12.47,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,40,,20.16,percent of total billed charges,40% of total billed charges,9.35,50.4,
"ANTI DNA, SINGLE STR",7000169,CDM,302,RC,86226,HCPCS,Outpatient,,,67,53.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,9.08,75,,,fee schedule,75% of CMS fee schedule,9.08,75,,,fee schedule,75% of CMS fee schedule,12.11,100,,,fee schedule,100% of CMS fee schedule,12.11,100,,,fee schedule,100% of CMS fee schedule,9.08,75,,,fee schedule,75% of CMS fee schedule,9.08,75,,,fee schedule,75% of CMS fee schedule,12.11,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,9.08,53.6,
ANTI STRIATED MUSCLE,7000169,CDM,302,RC,86255,HCPCS,Outpatient,,,99,79.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,9.04,79.2,
FTA/ABS IGG & IGM,7000169,CDM,302,RC,86780,HCPCS,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,9.93,75,,,fee schedule,75% of CMS fee schedule,9.93,75,,,fee schedule,75% of CMS fee schedule,13.24,100,,,fee schedule,100% of CMS fee schedule,13.24,100,,,fee schedule,100% of CMS fee schedule,9.93,75,,,fee schedule,75% of CMS fee schedule,9.93,75,,,fee schedule,75% of CMS fee schedule,13.24,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,9.93,59.2,
FOLIC ACID,7000029,CDM,301,RC,82746,HCPCS,Outpatient,,,83,66.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,11.03,75,,,fee schedule,75% of CMS fee schedule,11.03,75,,,fee schedule,75% of CMS fee schedule,14.7,100,,,fee schedule,100% of CMS fee schedule,14.7,100,,,fee schedule,100% of CMS fee schedule,11.03,75,,,fee schedule,75% of CMS fee schedule,11.03,75,,,fee schedule,75% of CMS fee schedule,14.7,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.2,40,,26.56,percent of total billed charges,40% of total billed charges,11.03,66.4,
RENIN ACTIVITY,7000029,CDM,301,RC,84244,HCPCS,Outpatient,,,181,144.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,16.49,75,,,fee schedule,75% of CMS fee schedule,16.49,75,,,fee schedule,75% of CMS fee schedule,21.99,100,,,fee schedule,100% of CMS fee schedule,21.99,100,,,fee schedule,100% of CMS fee schedule,16.49,75,,,fee schedule,75% of CMS fee schedule,16.49,75,,,fee schedule,75% of CMS fee schedule,21.99,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.4,40,,57.92,percent of total billed charges,40% of total billed charges,16.49,144.8,
CORTISOL FREE URINE,7000029,CDM,301,RC,82530,HCPCS,Outpatient,,,91,72.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,12.53,75,,,fee schedule,75% of CMS fee schedule,12.53,75,,,fee schedule,75% of CMS fee schedule,16.71,100,,,fee schedule,100% of CMS fee schedule,16.71,100,,,fee schedule,100% of CMS fee schedule,12.53,75,,,fee schedule,75% of CMS fee schedule,12.53,75,,,fee schedule,75% of CMS fee schedule,16.71,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.4,40,,29.12,percent of total billed charges,40% of total billed charges,12.53,72.8,
VITAMIN B12,7000029,CDM,301,RC,82607,HCPCS,Outpatient,,,84,67.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,31.31,37.27,,25.05,percent of total billed charges,37.27% of total billed charges,31.31,37.27,,25.05,percent of total billed charges,37.27% of total billed charges,31.31,37.27,,25.05,percent of total billed charges,37.27% of total billed charges,11.31,75,,,fee schedule,75% of CMS fee schedule,11.31,75,,,fee schedule,75% of CMS fee schedule,15.08,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of CMS fee schedule,11.31,75,,,fee schedule,75% of CMS fee schedule,11.31,75,,,fee schedule,75% of CMS fee schedule,15.08,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,40,,26.88,percent of total billed charges,40% of total billed charges,11.31,67.2,
"TESTOSTERONE, TOTAL",7000029,CDM,301,RC,84403,HCPCS,Outpatient,,,144,115.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,19.36,75,,,fee schedule,75% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,40,,46.08,percent of total billed charges,40% of total billed charges,19.36,115.2,
LECITHIN SPHINGOMYEL,7000029,CDM,301,RC,83664,HCPCS,Outpatient,,,211,168.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.8,80,,135.04,percent of total billed charges,80% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,14.49,75,,,fee schedule,75% of CMS fee schedule,14.49,75,,,fee schedule,75% of CMS fee schedule,19.32,100,,,fee schedule,100% of CMS fee schedule,19.32,100,,,fee schedule,100% of CMS fee schedule,14.49,75,,,fee schedule,75% of CMS fee schedule,14.49,75,,,fee schedule,75% of CMS fee schedule,19.32,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.4,40,,67.52,percent of total billed charges,40% of total billed charges,14.49,168.8,
TRANSFERRIN,7000029,CDM,301,RC,84466,HCPCS,Outpatient,,,71,56.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,9.57,75,,,fee schedule,75% of CMS fee schedule,9.57,75,,,fee schedule,75% of CMS fee schedule,12.76,100,,,fee schedule,100% of CMS fee schedule,12.76,100,,,fee schedule,100% of CMS fee schedule,9.57,75,,,fee schedule,75% of CMS fee schedule,9.57,75,,,fee schedule,75% of CMS fee schedule,12.76,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.4,40,,22.72,percent of total billed charges,40% of total billed charges,9.57,56.8,
OXALATE AS OXALIC AC,7000029,CDM,301,RC,83945,HCPCS,Outpatient,,,108,86.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,10.84,75,,,fee schedule,75% of CMS fee schedule,10.84,75,,,fee schedule,75% of CMS fee schedule,14.45,100,,,fee schedule,100% of CMS fee schedule,14.45,100,,,fee schedule,100% of CMS fee schedule,10.84,75,,,fee schedule,75% of CMS fee schedule,10.84,75,,,fee schedule,75% of CMS fee schedule,14.45,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,10.84,86.4,
OSMOLALITY SERUM,7000029,CDM,301,RC,83930,HCPCS,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,4.96,75,,,fee schedule,75% of CMS fee schedule,4.96,75,,,fee schedule,75% of CMS fee schedule,6.61,100,,,fee schedule,100% of CMS fee schedule,6.61,100,,,fee schedule,100% of CMS fee schedule,4.96,75,,,fee schedule,75% of CMS fee schedule,4.96,75,,,fee schedule,75% of CMS fee schedule,6.61,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,4.96,31.2,
URINE PREGNANCY TEST,7018237,CDM,307,RC,81025,HCPCS,Outpatient,,,43,34.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,6.46,75,,,fee schedule,75% of CMS fee schedule,6.46,75,,,fee schedule,75% of CMS fee schedule,8.61,100,,,fee schedule,100% of CMS fee schedule,8.61,100,,,fee schedule,100% of CMS fee schedule,6.46,75,,,fee schedule,75% of CMS fee schedule,6.46,75,,,fee schedule,75% of CMS fee schedule,8.61,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.2,40,,13.76,percent of total billed charges,40% of total billed charges,6.46,34.4,
DIGOXIN LEVELS,7000029,CDM,301,RC,80162,HCPCS,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,9.96,75,,,fee schedule,75% of CMS fee schedule,9.96,75,,,fee schedule,75% of CMS fee schedule,13.28,100,,,fee schedule,100% of CMS fee schedule,13.28,100,,,fee schedule,100% of CMS fee schedule,9.96,75,,,fee schedule,75% of CMS fee schedule,9.96,75,,,fee schedule,75% of CMS fee schedule,13.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,9.96,59.2,
GENTAMYCIN TROUGH,7000029,CDM,301,RC,80170,HCPCS,Outpatient,,,66,52.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,12.29,75,,,fee schedule,75% of CMS fee schedule,12.29,75,,,fee schedule,75% of CMS fee schedule,16.38,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of CMS fee schedule,12.29,75,,,fee schedule,75% of CMS fee schedule,12.29,75,,,fee schedule,75% of CMS fee schedule,16.38,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,12.29,52.8,
KETONES SERUM QUAL,7000029,CDM,301,RC,82009,HCPCS,Outpatient,,,46,36.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,3.39,75,,,fee schedule,75% of CMS fee schedule,3.39,75,,,fee schedule,75% of CMS fee schedule,4.52,100,,,fee schedule,100% of CMS fee schedule,4.52,100,,,fee schedule,100% of CMS fee schedule,3.39,75,,,fee schedule,75% of CMS fee schedule,3.39,75,,,fee schedule,75% of CMS fee schedule,4.52,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,3.39,36.8,
PSA FREE DX,7000029,CDM,301,RC,84154,HCPCS,Outpatient,,,181,144.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,13.79,75,,,fee schedule,75% of CMS fee schedule,13.79,75,,,fee schedule,75% of CMS fee schedule,18.39,100,,,fee schedule,100% of CMS fee schedule,18.39,100,,,fee schedule,100% of CMS fee schedule,13.79,75,,,fee schedule,75% of CMS fee schedule,13.79,75,,,fee schedule,75% of CMS fee schedule,18.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.4,40,,57.92,percent of total billed charges,40% of total billed charges,13.79,144.8,
CEA,7000029,CDM,301,RC,82378,HCPCS,Outpatient,,,105,84.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,14.22,75,,,fee schedule,75% of CMS fee schedule,14.22,75,,,fee schedule,75% of CMS fee schedule,18.96,100,,,fee schedule,100% of CMS fee schedule,18.96,100,,,fee schedule,100% of CMS fee schedule,14.22,75,,,fee schedule,75% of CMS fee schedule,14.22,75,,,fee schedule,75% of CMS fee schedule,18.96,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,40,,33.6,percent of total billed charges,40% of total billed charges,14.22,84,
PHOSPHORUS URINE,7000029,CDM,301,RC,84105,HCPCS,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,4.34,75,,,fee schedule,75% of CMS fee schedule,4.34,75,,,fee schedule,75% of CMS fee schedule,5.78,100,,,fee schedule,100% of CMS fee schedule,5.78,100,,,fee schedule,100% of CMS fee schedule,4.34,75,,,fee schedule,75% of CMS fee schedule,4.34,75,,,fee schedule,75% of CMS fee schedule,5.78,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,4.34,22.4,
SODIUM URINE 24 HR,7000029,CDM,301,RC,84300,HCPCS,Outpatient,,,41,32.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,3.8,75,,,fee schedule,75% of CMS fee schedule,3.8,75,,,fee schedule,75% of CMS fee schedule,5.06,100,,,fee schedule,100% of CMS fee schedule,5.06,100,,,fee schedule,100% of CMS fee schedule,3.8,75,,,fee schedule,75% of CMS fee schedule,3.8,75,,,fee schedule,75% of CMS fee schedule,5.06,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,3.8,32.8,
THYROID STIMULATING,7000029,CDM,301,RC,84445,HCPCS,Outpatient,,,153,122.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,57.02,37.27,,45.62,percent of total billed charges,37.27% of total billed charges,57.02,37.27,,45.62,percent of total billed charges,37.27% of total billed charges,57.02,37.27,,45.62,percent of total billed charges,37.27% of total billed charges,38.15,75,,,fee schedule,75% of CMS fee schedule,38.15,75,,,fee schedule,75% of CMS fee schedule,50.86,100,,,fee schedule,100% of CMS fee schedule,50.86,100,,,fee schedule,100% of CMS fee schedule,38.15,75,,,fee schedule,75% of CMS fee schedule,38.15,75,,,fee schedule,75% of CMS fee schedule,50.86,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.2,40,,48.96,percent of total billed charges,40% of total billed charges,38.15,122.4,
EBV DNA QUANTITATIVE,7000284,CDM,306,RC,87799,HCPCS,Outpatient,,,735,588.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,588,80,,470.4,percent of total billed charges,80% of total billed charges,273.93,37.27,,219.14,percent of total billed charges,37.27% of total billed charges,273.93,37.27,,219.14,percent of total billed charges,37.27% of total billed charges,273.93,37.27,,219.14,percent of total billed charges,37.27% of total billed charges,32.13,75,,,fee schedule,75% of CMS fee schedule,32.13,75,,,fee schedule,75% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,32.13,75,,,fee schedule,75% of CMS fee schedule,32.13,75,,,fee schedule,75% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294,40,,235.2,percent of total billed charges,40% of total billed charges,32.13,588,
"PSITTACOSIS AB, IGM",7000169,CDM,302,RC,86632,HCPCS,Outpatient,,,83,66.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,9.51,75,,,fee schedule,75% of CMS fee schedule,9.51,75,,,fee schedule,75% of CMS fee schedule,12.68,100,,,fee schedule,100% of CMS fee schedule,12.68,100,,,fee schedule,100% of CMS fee schedule,9.51,75,,,fee schedule,75% of CMS fee schedule,9.51,75,,,fee schedule,75% of CMS fee schedule,12.68,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.2,40,,26.56,percent of total billed charges,40% of total billed charges,9.51,66.4,
"POTASSIUM, URINE 24",7000029,CDM,301,RC,84133,HCPCS,Outpatient,,,31,24.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,3.55,75,,,fee schedule,75% of CMS fee schedule,3.55,75,,,fee schedule,75% of CMS fee schedule,4.73,100,,,fee schedule,100% of CMS fee schedule,4.73,100,,,fee schedule,100% of CMS fee schedule,3.55,75,,,fee schedule,75% of CMS fee schedule,3.55,75,,,fee schedule,75% of CMS fee schedule,4.73,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,3.55,24.8,
CA 27.29,7000169,CDM,302,RC,86300,HCPCS,Outpatient,,,136,108.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,15.61,75,,,fee schedule,75% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,15.61,108.8,
D-DIMER QUANTATIVE,7000177,CDM,305,RC,85379,HCPCS,Outpatient,,,63,50.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,7.64,75,,,fee schedule,75% of CMS fee schedule,7.64,75,,,fee schedule,75% of CMS fee schedule,10.18,100,,,fee schedule,100% of CMS fee schedule,10.18,100,,,fee schedule,100% of CMS fee schedule,7.64,75,,,fee schedule,75% of CMS fee schedule,7.64,75,,,fee schedule,75% of CMS fee schedule,10.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,40,,20.16,percent of total billed charges,40% of total billed charges,7.64,50.4,
PROTEIN C RESISTANCE,7000177,CDM,305,RC,85307,HCPCS,Outpatient,,,172,137.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% of total billed charges,11.49,75,,,fee schedule,75% of CMS fee schedule,11.49,75,,,fee schedule,75% of CMS fee schedule,15.32,100,,,fee schedule,100% of CMS fee schedule,15.32,100,,,fee schedule,100% of CMS fee schedule,11.49,75,,,fee schedule,75% of CMS fee schedule,11.49,75,,,fee schedule,75% of CMS fee schedule,15.32,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.8,40,,55.04,percent of total billed charges,40% of total billed charges,11.49,137.6,
INHIBIN B,7000029,CDM,301,RC,83520,HCPCS,Outpatient,,,276,220.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.8,80,,176.64,percent of total billed charges,80% of total billed charges,102.87,37.27,,82.3,percent of total billed charges,37.27% of total billed charges,102.87,37.27,,82.3,percent of total billed charges,37.27% of total billed charges,102.87,37.27,,82.3,percent of total billed charges,37.27% of total billed charges,12.95,75,,,fee schedule,75% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.4,40,,88.32,percent of total billed charges,40% of total billed charges,12.95,220.8,
PRE-ALBUMIN,7000029,CDM,301,RC,84134,HCPCS,Outpatient,,,62,49.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,10.94,75,,,fee schedule,75% of CMS fee schedule,10.94,75,,,fee schedule,75% of CMS fee schedule,14.59,100,,,fee schedule,100% of CMS fee schedule,14.59,100,,,fee schedule,100% of CMS fee schedule,10.94,75,,,fee schedule,75% of CMS fee schedule,10.94,75,,,fee schedule,75% of CMS fee schedule,14.59,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,40,,19.84,percent of total billed charges,40% of total billed charges,10.94,49.6,
"CAT SCRATCH ABS, IGG",7000169,CDM,302,RC,86611,HCPCS,Outpatient,,,57,45.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,7.64,75,,,fee schedule,75% of CMS fee schedule,7.64,75,,,fee schedule,75% of CMS fee schedule,10.18,100,,,fee schedule,100% of CMS fee schedule,10.18,100,,,fee schedule,100% of CMS fee schedule,7.64,75,,,fee schedule,75% of CMS fee schedule,7.64,75,,,fee schedule,75% of CMS fee schedule,10.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,40,,18.24,percent of total billed charges,40% of total billed charges,7.64,45.6,
"PROTEIN, RANDOM URIN",7000029,CDM,301,RC,84156,HCPCS,Outpatient,,,27,21.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,2.75,75,,,fee schedule,75% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,2.75,21.6,
ANA,7000169,CDM,302,RC,86038,HCPCS,Outpatient,,,67,53.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,9.07,75,,,fee schedule,75% of CMS fee schedule,9.07,75,,,fee schedule,75% of CMS fee schedule,12.09,100,,,fee schedule,100% of CMS fee schedule,12.09,100,,,fee schedule,100% of CMS fee schedule,9.07,75,,,fee schedule,75% of CMS fee schedule,9.07,75,,,fee schedule,75% of CMS fee schedule,12.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,9.07,53.6,
LIPASE,7000029,CDM,301,RC,83690,HCPCS,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,5.17,75,,,fee schedule,75% of CMS fee schedule,5.17,75,,,fee schedule,75% of CMS fee schedule,6.89,100,,,fee schedule,100% of CMS fee schedule,6.89,100,,,fee schedule,100% of CMS fee schedule,5.17,75,,,fee schedule,75% of CMS fee schedule,5.17,75,,,fee schedule,75% of CMS fee schedule,6.89,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,5.17,31.2,
HEPATIC FUNCTION PAN,7000029,CDM,301,RC,80076,HCPCS,Outpatient,,,46,36.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,6.13,75,,,fee schedule,75% of CMS fee schedule,6.13,75,,,fee schedule,75% of CMS fee schedule,8.17,100,,,fee schedule,100% of CMS fee schedule,8.17,100,,,fee schedule,100% of CMS fee schedule,6.13,75,,,fee schedule,75% of CMS fee schedule,6.13,75,,,fee schedule,75% of CMS fee schedule,8.17,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,6.13,36.8,
"RUBELLA, IGG IMMUNIT",7000169,CDM,302,RC,86762,HCPCS,Outpatient,,,80,64.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,10.79,75,,,fee schedule,75% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,40,,25.6,percent of total billed charges,40% of total billed charges,10.79,64,
CAROTENE SERUM,7000029,CDM,301,RC,82380,HCPCS,Outpatient,,,69,55.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,6.92,75,,,fee schedule,75% of CMS fee schedule,6.92,75,,,fee schedule,75% of CMS fee schedule,9.22,100,,,fee schedule,100% of CMS fee schedule,9.22,100,,,fee schedule,100% of CMS fee schedule,6.92,75,,,fee schedule,75% of CMS fee schedule,6.92,75,,,fee schedule,75% of CMS fee schedule,9.22,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.6,40,,22.08,percent of total billed charges,40% of total billed charges,6.92,55.2,
CERULOPLASMIN SERUM,7000029,CDM,301,RC,82390,HCPCS,Outpatient,,,59,47.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,8.06,75,,,fee schedule,75% of CMS fee schedule,8.06,75,,,fee schedule,75% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,8.06,75,,,fee schedule,75% of CMS fee schedule,8.06,75,,,fee schedule,75% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.6,40,,18.88,percent of total billed charges,40% of total billed charges,8.06,47.2,
IMMUNOFIXATION URINE,7000169,CDM,302,RC,86335,HCPCS,Outpatient,,,143,114.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% of total billed charges,22.01,75,,,fee schedule,75% of CMS fee schedule,22.01,75,,,fee schedule,75% of CMS fee schedule,29.35,100,,,fee schedule,100% of CMS fee schedule,29.35,100,,,fee schedule,100% of CMS fee schedule,22.01,75,,,fee schedule,75% of CMS fee schedule,22.01,75,,,fee schedule,75% of CMS fee schedule,29.35,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.2,40,,45.76,percent of total billed charges,40% of total billed charges,22.01,114.4,
ELECTROLYTES,7000029,CDM,301,RC,80051,HCPCS,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,5.26,75,,,fee schedule,75% of CMS fee schedule,5.26,75,,,fee schedule,75% of CMS fee schedule,7.01,100,,,fee schedule,100% of CMS fee schedule,7.01,100,,,fee schedule,100% of CMS fee schedule,5.26,75,,,fee schedule,75% of CMS fee schedule,5.26,75,,,fee schedule,75% of CMS fee schedule,7.01,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,5.26,31.2,
INSULIN SERUM,7000029,CDM,301,RC,83525,HCPCS,Outpatient,,,54.5,43.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.6,80,,34.88,percent of total billed charges,80% of total billed charges,20.31,37.27,,16.25,percent of total billed charges,37.27% of total billed charges,20.31,37.27,,16.25,percent of total billed charges,37.27% of total billed charges,20.31,37.27,,16.25,percent of total billed charges,37.27% of total billed charges,8.57,75,,,fee schedule,75% of CMS fee schedule,8.57,75,,,fee schedule,75% of CMS fee schedule,11.43,100,,,fee schedule,100% of CMS fee schedule,11.43,100,,,fee schedule,100% of CMS fee schedule,8.57,75,,,fee schedule,75% of CMS fee schedule,8.57,75,,,fee schedule,75% of CMS fee schedule,11.43,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.8,40,,17.44,percent of total billed charges,40% of total billed charges,8.57,43.6,
LACTIC ACID,7000029,CDM,301,RC,83605,HCPCS,Outpatient,,,94,75.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,8.68,75,,,fee schedule,75% of CMS fee schedule,8.68,75,,,fee schedule,75% of CMS fee schedule,11.57,100,,,fee schedule,100% of CMS fee schedule,11.57,100,,,fee schedule,100% of CMS fee schedule,8.68,75,,,fee schedule,75% of CMS fee schedule,8.68,75,,,fee schedule,75% of CMS fee schedule,11.57,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,8.68,75.2,
DILANTIN LEVEL,7000029,CDM,301,RC,80185,HCPCS,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,9.94,75,,,fee schedule,75% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,9.94,59.2,
PHENOBARBITAL LEVEL,7000029,CDM,301,RC,80184,HCPCS,Outpatient,,,64,51.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,11.48,75,,,fee schedule,75% of CMS fee schedule,11.48,75,,,fee schedule,75% of CMS fee schedule,15.3,100,,,fee schedule,100% of CMS fee schedule,15.3,100,,,fee schedule,100% of CMS fee schedule,11.48,75,,,fee schedule,75% of CMS fee schedule,11.48,75,,,fee schedule,75% of CMS fee schedule,15.3,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,11.48,51.2,
PROLACTIN SERUM,7000029,CDM,301,RC,84146,HCPCS,Outpatient,,,109,87.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,14.54,75,,,fee schedule,75% of CMS fee schedule,14.54,75,,,fee schedule,75% of CMS fee schedule,19.38,100,,,fee schedule,100% of CMS fee schedule,19.38,100,,,fee schedule,100% of CMS fee schedule,14.54,75,,,fee schedule,75% of CMS fee schedule,14.54,75,,,fee schedule,75% of CMS fee schedule,19.38,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.6,40,,34.88,percent of total billed charges,40% of total billed charges,14.54,87.2,
HCG QUANTITATIVE SER,7000029,CDM,301,RC,84702,HCPCS,Outpatient,,,70.85,56.68,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.68,80,,45.34,percent of total billed charges,80% of total billed charges,26.41,37.27,,21.13,percent of total billed charges,37.27% of total billed charges,26.41,37.27,,21.13,percent of total billed charges,37.27% of total billed charges,26.41,37.27,,21.13,percent of total billed charges,37.27% of total billed charges,11.29,75,,,fee schedule,75% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.34,40,,22.67,percent of total billed charges,40% of total billed charges,11.29,56.68,
LUTEINIZING HORMONE,7000029,CDM,301,RC,83002,HCPCS,Outpatient,,,104,83.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,38.76,37.27,,31.01,percent of total billed charges,37.27% of total billed charges,38.76,37.27,,31.01,percent of total billed charges,37.27% of total billed charges,38.76,37.27,,31.01,percent of total billed charges,37.27% of total billed charges,13.89,75,,,fee schedule,75% of CMS fee schedule,13.89,75,,,fee schedule,75% of CMS fee schedule,18.52,100,,,fee schedule,100% of CMS fee schedule,18.52,100,,,fee schedule,100% of CMS fee schedule,13.89,75,,,fee schedule,75% of CMS fee schedule,13.89,75,,,fee schedule,75% of CMS fee schedule,18.52,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,40,,33.28,percent of total billed charges,40% of total billed charges,13.89,83.2,
HLA B27,7000169,CDM,302,RC,86812,HCPCS,Outpatient,,,221,176.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,82.37,37.27,,65.9,percent of total billed charges,37.27% of total billed charges,82.37,37.27,,65.9,percent of total billed charges,37.27% of total billed charges,82.37,37.27,,65.9,percent of total billed charges,37.27% of total billed charges,19.36,75,,,fee schedule,75% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.4,40,,70.72,percent of total billed charges,40% of total billed charges,19.36,176.8,
HDL CHOL,7000029,CDM,301,RC,83718,HCPCS,Outpatient,,,46,36.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,6.14,75,,,fee schedule,75% of CMS fee schedule,6.14,75,,,fee schedule,75% of CMS fee schedule,8.19,100,,,fee schedule,100% of CMS fee schedule,8.19,100,,,fee schedule,100% of CMS fee schedule,6.14,75,,,fee schedule,75% of CMS fee schedule,6.14,75,,,fee schedule,75% of CMS fee schedule,8.19,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,6.14,36.8,
THEOPHYLLINE LEVEL,7000029,CDM,301,RC,80198,HCPCS,Outpatient,,,80,64.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,10.61,75,,,fee schedule,75% of CMS fee schedule,10.61,75,,,fee schedule,75% of CMS fee schedule,14.14,100,,,fee schedule,100% of CMS fee schedule,14.14,100,,,fee schedule,100% of CMS fee schedule,10.61,75,,,fee schedule,75% of CMS fee schedule,10.61,75,,,fee schedule,75% of CMS fee schedule,14.14,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,40,,25.6,percent of total billed charges,40% of total billed charges,10.61,64,
IMMUNOGLOBULIN E,7000029,CDM,301,RC,82785,HCPCS,Outpatient,,,92,73.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,12.35,75,,,fee schedule,75% of CMS fee schedule,12.35,75,,,fee schedule,75% of CMS fee schedule,16.46,100,,,fee schedule,100% of CMS fee schedule,16.46,100,,,fee schedule,100% of CMS fee schedule,12.35,75,,,fee schedule,75% of CMS fee schedule,12.35,75,,,fee schedule,75% of CMS fee schedule,16.46,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,40,,29.44,percent of total billed charges,40% of total billed charges,12.35,73.6,
"HEPATITIS A AB,TOTAL",7000169,CDM,302,RC,86708,HCPCS,Outpatient,,,66,52.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,9.29,75,,,fee schedule,75% of CMS fee schedule,9.29,75,,,fee schedule,75% of CMS fee schedule,12.39,100,,,fee schedule,100% of CMS fee schedule,12.39,100,,,fee schedule,100% of CMS fee schedule,9.29,75,,,fee schedule,75% of CMS fee schedule,9.29,75,,,fee schedule,75% of CMS fee schedule,12.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,9.29,52.8,
MYSOLINE,7000029,CDM,301,RC,80188,HCPCS,Outpatient,,,92,73.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,12.44,75,,,fee schedule,75% of CMS fee schedule,12.44,75,,,fee schedule,75% of CMS fee schedule,16.59,100,,,fee schedule,100% of CMS fee schedule,16.59,100,,,fee schedule,100% of CMS fee schedule,12.44,75,,,fee schedule,75% of CMS fee schedule,12.44,75,,,fee schedule,75% of CMS fee schedule,16.59,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,40,,29.44,percent of total billed charges,40% of total billed charges,12.44,73.6,
HEPATITIS B CORE ANT,7000169,CDM,302,RC,86704,HCPCS,Outpatient,,,67,53.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,9.04,53.6,
TSH,7000029,CDM,301,RC,84443,HCPCS,Outpatient,,,94,75.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,12.6,75,,,fee schedule,75% of CMS fee schedule,12.6,75,,,fee schedule,75% of CMS fee schedule,16.8,100,,,fee schedule,100% of CMS fee schedule,16.8,100,,,fee schedule,100% of CMS fee schedule,12.6,75,,,fee schedule,75% of CMS fee schedule,12.6,75,,,fee schedule,75% of CMS fee schedule,16.8,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,12.6,75.2,
"URIC ACID, URINE",7000029,CDM,301,RC,84560,HCPCS,Outpatient,,,32,25.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,3.81,75,,,fee schedule,75% of CMS fee schedule,3.81,75,,,fee schedule,75% of CMS fee schedule,5.08,100,,,fee schedule,100% of CMS fee schedule,5.08,100,,,fee schedule,100% of CMS fee schedule,3.81,75,,,fee schedule,75% of CMS fee schedule,3.81,75,,,fee schedule,75% of CMS fee schedule,5.08,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,40,,10.24,percent of total billed charges,40% of total billed charges,3.81,25.6,
"MAGNESIUM, URINE",7000029,CDM,301,RC,83735,HCPCS,Outpatient,,,108,86.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,5.03,75,,,fee schedule,75% of CMS fee schedule,5.03,75,,,fee schedule,75% of CMS fee schedule,6.7,100,,,fee schedule,100% of CMS fee schedule,6.7,100,,,fee schedule,100% of CMS fee schedule,5.03,75,,,fee schedule,75% of CMS fee schedule,5.03,75,,,fee schedule,75% of CMS fee schedule,6.7,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,5.03,86.4,
PARATHYROID HORMONE-,7000029,CDM,301,RC,83970,HCPCS,Outpatient,,,231,184.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% of total billed charges,30.96,75,,,fee schedule,75% of CMS fee schedule,30.96,75,,,fee schedule,75% of CMS fee schedule,41.28,100,,,fee schedule,100% of CMS fee schedule,41.28,100,,,fee schedule,100% of CMS fee schedule,30.96,75,,,fee schedule,75% of CMS fee schedule,30.96,75,,,fee schedule,75% of CMS fee schedule,41.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.4,40,,73.92,percent of total billed charges,40% of total billed charges,30.96,184.8,
LIVER KIDNEY MICRO A,7000169,CDM,302,RC,86376,HCPCS,Outpatient,,,99,79.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,10.91,75,,,fee schedule,75% of CMS fee schedule,10.91,75,,,fee schedule,75% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,10.91,75,,,fee schedule,75% of CMS fee schedule,10.91,75,,,fee schedule,75% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,10.91,79.2,
"HCG-B, TUMOR MARKER",7000029,CDM,301,RC,84702,HCPCS,Outpatient,,,146,116.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,11.29,75,,,fee schedule,75% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,11.29,116.8,
WET PREP,7000284,CDM,306,RC,87210,HCPCS,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,4.37,75,,,fee schedule,75% of CMS fee schedule,4.37,75,,,fee schedule,75% of CMS fee schedule,5.82,100,,,fee schedule,100% of CMS fee schedule,5.82,100,,,fee schedule,100% of CMS fee schedule,4.37,75,,,fee schedule,75% of CMS fee schedule,4.37,75,,,fee schedule,75% of CMS fee schedule,5.82,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,4.37,39.2,
VASOACTIVE INTESTINA,7000029,CDM,301,RC,83519,HCPCS,Outpatient,,,136,108.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,13.8,75,,,fee schedule,75% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,13.8,108.8,
DILUTE RUSSELL VIPER,7000177,CDM,305,RC,85613,HCPCS,Outpatient,,,108,86.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,7.19,75,,,fee schedule,75% of CMS fee schedule,7.19,75,,,fee schedule,75% of CMS fee schedule,9.58,100,,,fee schedule,100% of CMS fee schedule,9.58,100,,,fee schedule,100% of CMS fee schedule,7.19,75,,,fee schedule,75% of CMS fee schedule,7.19,75,,,fee schedule,75% of CMS fee schedule,9.58,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,7.19,86.4,
"CREATININE, URN,RNDM",7000029,CDM,301,RC,82570,HCPCS,Outpatient,,,50,40.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,3.89,75,,,fee schedule,75% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,3.89,75,,,fee schedule,75% of CMS fee schedule,5.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,40,,16,percent of total billed charges,40% of total billed charges,3.89,40,
"PROTEIN, SPINAL FLUI",7000029,CDM,301,RC,84157,HCPCS,Outpatient,,,22,17.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,3,75,,,fee schedule,75% of CMS fee schedule,3,75,,,fee schedule,75% of CMS fee schedule,4,100,,,fee schedule,100% of CMS fee schedule,4,100,,,fee schedule,100% of CMS fee schedule,3,75,,,fee schedule,75% of CMS fee schedule,3,75,,,fee schedule,75% of CMS fee schedule,4,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,3,17.6,
SPINAL FLUID GLUCOSE,7000029,CDM,301,RC,82945,HCPCS,Outpatient,,,22,17.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,2.95,75,,,fee schedule,75% of CMS fee schedule,2.95,75,,,fee schedule,75% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,2.95,75,,,fee schedule,75% of CMS fee schedule,2.95,75,,,fee schedule,75% of CMS fee schedule,3.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,2.95,17.6,
"HEP, BS ANTIGN SCREE",7000284,CDM,306,RC,87340,HCPCS,Outpatient,,,59,47.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,7.75,75,,,fee schedule,75% of CMS fee schedule,7.75,75,,,fee schedule,75% of CMS fee schedule,10.33,100,,,fee schedule,100% of CMS fee schedule,10.33,100,,,fee schedule,100% of CMS fee schedule,7.75,75,,,fee schedule,75% of CMS fee schedule,7.75,75,,,fee schedule,75% of CMS fee schedule,10.33,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.6,40,,18.88,percent of total billed charges,40% of total billed charges,7.75,47.2,
"HEP, BS AB, DIAG",7000169,CDM,302,RC,86706,HCPCS,Outpatient,,,60,48.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,8.06,75,,,fee schedule,75% of CMS fee schedule,8.06,75,,,fee schedule,75% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,8.06,75,,,fee schedule,75% of CMS fee schedule,8.06,75,,,fee schedule,75% of CMS fee schedule,10.74,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,40,,19.2,percent of total billed charges,40% of total billed charges,8.06,48,
"ANTIBODY, VIRAL",7000169,CDM,302,RC,86790,HCPCS,Outpatient,,,148,118.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.4,80,,94.72,percent of total billed charges,80% of total billed charges,55.16,37.27,,44.13,percent of total billed charges,37.27% of total billed charges,55.16,37.27,,44.13,percent of total billed charges,37.27% of total billed charges,55.16,37.27,,44.13,percent of total billed charges,37.27% of total billed charges,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,40,,47.36,percent of total billed charges,40% of total billed charges,9.66,118.4,
CELIAC DISEASE PANEL,7000029,CDM,301,RC,83520,HCPCS,Outpatient,,,263,210.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,12.95,75,,,fee schedule,75% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.2,40,,84.16,percent of total billed charges,40% of total billed charges,12.95,210.4,
FIBRIN DEGRADATION P,7000177,CDM,305,RC,85362,HCPCS,Outpatient,,,48,38.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,5.17,75,,,fee schedule,75% of CMS fee schedule,5.17,75,,,fee schedule,75% of CMS fee schedule,6.89,100,,,fee schedule,100% of CMS fee schedule,6.89,100,,,fee schedule,100% of CMS fee schedule,5.17,75,,,fee schedule,75% of CMS fee schedule,5.17,75,,,fee schedule,75% of CMS fee schedule,6.89,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,40,,15.36,percent of total billed charges,40% of total billed charges,5.17,38.4,
"HOMOCYSTEINE, SERUM",7000029,CDM,301,RC,83090,HCPCS,Outpatient,,,109,87.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,13.44,75,,,fee schedule,75% of CMS fee schedule,13.44,75,,,fee schedule,75% of CMS fee schedule,17.92,100,,,fee schedule,100% of CMS fee schedule,17.92,100,,,fee schedule,100% of CMS fee schedule,13.44,75,,,fee schedule,75% of CMS fee schedule,13.44,75,,,fee schedule,75% of CMS fee schedule,17.92,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.6,40,,34.88,percent of total billed charges,40% of total billed charges,13.44,87.2,
PLATELET ASSOCIATED,7000169,CDM,302,RC,86023,HCPCS,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,9.35,75,,,fee schedule,75% of CMS fee schedule,9.35,75,,,fee schedule,75% of CMS fee schedule,12.46,100,,,fee schedule,100% of CMS fee schedule,12.46,100,,,fee schedule,100% of CMS fee schedule,9.35,75,,,fee schedule,75% of CMS fee schedule,9.35,75,,,fee schedule,75% of CMS fee schedule,12.46,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28,40,,22.4,percent of total billed charges,40% of total billed charges,9.35,56,
PRO INSULIN LEVEL,7000029,CDM,301,RC,84206,HCPCS,Outpatient,,,84.91,67.93,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.93,80,,54.34,percent of total billed charges,80% of total billed charges,31.65,37.27,,25.32,percent of total billed charges,37.27% of total billed charges,31.65,37.27,,25.32,percent of total billed charges,37.27% of total billed charges,31.65,37.27,,25.32,percent of total billed charges,37.27% of total billed charges,20.02,75,,,fee schedule,75% of CMS fee schedule,20.02,75,,,fee schedule,75% of CMS fee schedule,26.69,100,,,fee schedule,100% of CMS fee schedule,26.69,100,,,fee schedule,100% of CMS fee schedule,20.02,75,,,fee schedule,75% of CMS fee schedule,20.02,75,,,fee schedule,75% of CMS fee schedule,26.69,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.96,40,,27.17,percent of total billed charges,40% of total billed charges,20.02,67.93,
HELIBACT PYL ANT-IGA,7000169,CDM,302,RC,86677,HCPCS,Outpatient,,,119,95.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,12.64,75,,,fee schedule,75% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.6,40,,38.08,percent of total billed charges,40% of total billed charges,12.64,95.2,
HELIBACT PYL ANT-IGG,7000169,CDM,302,RC,86677,HCPCS,Outpatient,,,105,84.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,12.64,75,,,fee schedule,75% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,40,,33.6,percent of total billed charges,40% of total billed charges,12.64,84,
TOPIRAMATE LEVEL,7000029,CDM,301,RC,80201,HCPCS,Outpatient,,,143,114.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% of total billed charges,8.94,75,,,fee schedule,75% of CMS fee schedule,8.94,75,,,fee schedule,75% of CMS fee schedule,11.92,100,,,fee schedule,100% of CMS fee schedule,11.92,100,,,fee schedule,100% of CMS fee schedule,8.94,75,,,fee schedule,75% of CMS fee schedule,8.94,75,,,fee schedule,75% of CMS fee schedule,11.92,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.2,40,,45.76,percent of total billed charges,40% of total billed charges,8.94,114.4,
"PKU, PHENYLALANINE B",7000029,CDM,301,RC,84030,HCPCS,Outpatient,,,31,24.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,4.13,75,,,fee schedule,75% of CMS fee schedule,4.13,75,,,fee schedule,75% of CMS fee schedule,5.5,100,,,fee schedule,100% of CMS fee schedule,5.5,100,,,fee schedule,100% of CMS fee schedule,4.13,75,,,fee schedule,75% of CMS fee schedule,4.13,75,,,fee schedule,75% of CMS fee schedule,5.5,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,4.13,24.8,
HCV RNA PCR QUANTIFI,7000284,CDM,306,RC,87522,HCPCS,Outpatient,,,375,300.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,32.13,75,,,fee schedule,75% of CMS fee schedule,32.13,75,,,fee schedule,75% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,32.13,75,,,fee schedule,75% of CMS fee schedule,32.13,75,,,fee schedule,75% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,32.13,300,
"SSA, SSB ANTIBODIES",7000169,CDM,302,RC,86235,HCPCS,Outpatient,,,81,64.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,40,,25.92,percent of total billed charges,40% of total billed charges,13.45,64.8,
"PH, FLUID",7000029,CDM,301,RC,83986,HCPCS,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,2.69,75,,,fee schedule,75% of CMS fee schedule,2.69,75,,,fee schedule,75% of CMS fee schedule,3.58,100,,,fee schedule,100% of CMS fee schedule,3.58,100,,,fee schedule,100% of CMS fee schedule,2.69,75,,,fee schedule,75% of CMS fee schedule,2.69,75,,,fee schedule,75% of CMS fee schedule,3.58,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,2.69,16,
VITAMIN A,7000029,CDM,301,RC,84590,HCPCS,Outpatient,,,77,61.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,8.71,75,,,fee schedule,75% of CMS fee schedule,8.71,75,,,fee schedule,75% of CMS fee schedule,11.61,100,,,fee schedule,100% of CMS fee schedule,11.61,100,,,fee schedule,100% of CMS fee schedule,8.71,75,,,fee schedule,75% of CMS fee schedule,8.71,75,,,fee schedule,75% of CMS fee schedule,11.61,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,8.71,61.6,
ANTI-DNA ANTBDY-DBL,7000169,CDM,302,RC,86225,HCPCS,Outpatient,,,183,146.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% of total billed charges,10.31,75,,,fee schedule,75% of CMS fee schedule,10.31,75,,,fee schedule,75% of CMS fee schedule,13.74,100,,,fee schedule,100% of CMS fee schedule,13.74,100,,,fee schedule,100% of CMS fee schedule,10.31,75,,,fee schedule,75% of CMS fee schedule,10.31,75,,,fee schedule,75% of CMS fee schedule,13.74,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,40,,58.56,percent of total billed charges,40% of total billed charges,10.31,146.4,
BRAIN NATRIURETIC PE,7000029,CDM,301,RC,83880,HCPCS,Outpatient,,,286,228.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,29.45,75,,,fee schedule,75% of CMS fee schedule,29.45,75,,,fee schedule,75% of CMS fee schedule,39.26,100,,,fee schedule,100% of CMS fee schedule,39.26,100,,,fee schedule,100% of CMS fee schedule,29.45,75,,,fee schedule,75% of CMS fee schedule,29.45,75,,,fee schedule,75% of CMS fee schedule,39.26,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.4,40,,91.52,percent of total billed charges,40% of total billed charges,29.45,228.8,
HANTA ANTIBODY,7000169,CDM,302,RC,86790,HCPCS,Outpatient,,,97,77.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.8,40,,31.04,percent of total billed charges,40% of total billed charges,9.66,77.6,
GENTAMICIN PEAK,7000029,CDM,301,RC,80170,HCPCS,Outpatient,,,66,52.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,12.29,75,,,fee schedule,75% of CMS fee schedule,12.29,75,,,fee schedule,75% of CMS fee schedule,16.38,100,,,fee schedule,100% of CMS fee schedule,16.38,100,,,fee schedule,100% of CMS fee schedule,12.29,75,,,fee schedule,75% of CMS fee schedule,12.29,75,,,fee schedule,75% of CMS fee schedule,16.38,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,12.29,52.8,
ADENOVIRUS ANTIBODY,7000169,CDM,302,RC,86603,HCPCS,Outpatient,,,172,137.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% of total billed charges,9.65,75,,,fee schedule,75% of CMS fee schedule,9.65,75,,,fee schedule,75% of CMS fee schedule,12.87,100,,,fee schedule,100% of CMS fee schedule,12.87,100,,,fee schedule,100% of CMS fee schedule,9.65,75,,,fee schedule,75% of CMS fee schedule,9.65,75,,,fee schedule,75% of CMS fee schedule,12.87,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.8,40,,55.04,percent of total billed charges,40% of total billed charges,9.65,137.6,
TETANUS ANTIBODY,7000169,CDM,302,RC,86774,HCPCS,Outpatient,,,162,129.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,11.1,75,,,fee schedule,75% of CMS fee schedule,11.1,75,,,fee schedule,75% of CMS fee schedule,14.8,100,,,fee schedule,100% of CMS fee schedule,14.8,100,,,fee schedule,100% of CMS fee schedule,11.1,75,,,fee schedule,75% of CMS fee schedule,11.1,75,,,fee schedule,75% of CMS fee schedule,14.8,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,40,,51.84,percent of total billed charges,40% of total billed charges,11.1,129.6,
DIPTHERIA ANTIBODY,7000169,CDM,302,RC,86648,HCPCS,Outpatient,,,162,129.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,11.41,75,,,fee schedule,75% of CMS fee schedule,11.41,75,,,fee schedule,75% of CMS fee schedule,15.21,100,,,fee schedule,100% of CMS fee schedule,15.21,100,,,fee schedule,100% of CMS fee schedule,11.41,75,,,fee schedule,75% of CMS fee schedule,11.41,75,,,fee schedule,75% of CMS fee schedule,15.21,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,40,,51.84,percent of total billed charges,40% of total billed charges,11.41,129.6,
SCL70 ANTIBODY,7000169,CDM,302,RC,86235,HCPCS,Outpatient,,,140,112.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112,80,,89.6,percent of total billed charges,80% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,40,,44.8,percent of total billed charges,40% of total billed charges,13.45,112,
TRILEPTAL LEVEL(OXCA,7000029,CDM,301,RC,80183,HCPCS,Outpatient,,,239,191.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,9.94,75,,,fee schedule,75% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.6,40,,76.48,percent of total billed charges,40% of total billed charges,9.94,191.2,
C ANCA,7000169,CDM,302,RC,86021,HCPCS,Outpatient,,,199,159.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,11.29,75,,,fee schedule,75% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.6,40,,63.68,percent of total billed charges,40% of total billed charges,11.29,159.2,
HUMAN PAPILLOMA VIRU,7000284,CDM,306,RC,87624,HCPCS,Outpatient,,,197,157.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.8,40,,63.04,percent of total billed charges,40% of total billed charges,26.32,157.6,
ANTI JO-1,7000169,CDM,302,RC,86235,HCPCS,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,13.45,59.2,
ALLERGEN SPECIFIC IG,7000169,CDM,302,RC,86008,HCPCS,Outpatient,,,129,103.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,48.08,37.27,,38.46,percent of total billed charges,37.27% of total billed charges,48.08,37.27,,38.46,percent of total billed charges,37.27% of total billed charges,48.08,37.27,,38.46,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.6,40,,41.28,percent of total billed charges,40% of total billed charges,13.45,103.2,
TSH RECEPTOR ANTIBOD,7000029,CDM,301,RC,84235,HCPCS,Outpatient,,,293,234.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.4,80,,187.52,percent of total billed charges,80% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% of total billed charges,53.42,75,,,fee schedule,75% of CMS fee schedule,53.42,75,,,fee schedule,75% of CMS fee schedule,71.23,100,,,fee schedule,100% of CMS fee schedule,71.23,100,,,fee schedule,100% of CMS fee schedule,53.42,75,,,fee schedule,75% of CMS fee schedule,53.42,75,,,fee schedule,75% of CMS fee schedule,71.23,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.2,40,,93.76,percent of total billed charges,40% of total billed charges,53.42,234.4,
"VDRL, CSF",7000169,CDM,302,RC,86592,HCPCS,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,3.2,22.4,
"HEP B CORE AB, DIAG",7000169,CDM,302,RC,86704,HCPCS,Outpatient,,,67,53.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,9.04,75,,,fee schedule,75% of CMS fee schedule,12.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,9.04,53.6,
ALPHA 1 ANTI TRYPSIN,7000029,CDM,301,RC,82103,HCPCS,Outpatient,,,69.44,55.55,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.55,80,,44.44,percent of total billed charges,80% of total billed charges,25.88,37.27,,20.7,percent of total billed charges,37.27% of total billed charges,25.88,37.27,,20.7,percent of total billed charges,37.27% of total billed charges,25.88,37.27,,20.7,percent of total billed charges,37.27% of total billed charges,10.08,75,,,fee schedule,75% of CMS fee schedule,10.08,75,,,fee schedule,75% of CMS fee schedule,13.44,100,,,fee schedule,100% of CMS fee schedule,13.44,100,,,fee schedule,100% of CMS fee schedule,10.08,75,,,fee schedule,75% of CMS fee schedule,10.08,75,,,fee schedule,75% of CMS fee schedule,13.44,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.78,40,,22.22,percent of total billed charges,40% of total billed charges,10.08,55.55,
"STOOL FAT, QUANTITAT",7000029,CDM,301,RC,82710,HCPCS,Outpatient,,,94,75.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,12.6,75,,,fee schedule,75% of CMS fee schedule,12.6,75,,,fee schedule,75% of CMS fee schedule,16.8,100,,,fee schedule,100% of CMS fee schedule,16.8,100,,,fee schedule,100% of CMS fee schedule,12.6,75,,,fee schedule,75% of CMS fee schedule,12.6,75,,,fee schedule,75% of CMS fee schedule,16.8,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,12.6,75.2,
"DILANTIN, FREE",7000029,CDM,301,RC,80186,HCPCS,Outpatient,,,109,87.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,10.32,75,,,fee schedule,75% of CMS fee schedule,10.32,75,,,fee schedule,75% of CMS fee schedule,13.76,100,,,fee schedule,100% of CMS fee schedule,13.76,100,,,fee schedule,100% of CMS fee schedule,10.32,75,,,fee schedule,75% of CMS fee schedule,10.32,75,,,fee schedule,75% of CMS fee schedule,13.76,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.6,40,,34.88,percent of total billed charges,40% of total billed charges,10.32,87.2,
HIV STAT,7000169,CDM,302,RC,86703,HCPCS,Outpatient,,,76,60.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,10.28,75,,,fee schedule,75% of CMS fee schedule,10.28,75,,,fee schedule,75% of CMS fee schedule,13.71,100,,,fee schedule,100% of CMS fee schedule,13.71,100,,,fee schedule,100% of CMS fee schedule,10.28,75,,,fee schedule,75% of CMS fee schedule,10.28,75,,,fee schedule,75% of CMS fee schedule,13.71,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,40,,24.32,percent of total billed charges,40% of total billed charges,10.28,60.8,
"HBV DNA PCR, QUALITA",7000284,CDM,306,RC,87516,HCPCS,Outpatient,,,197,157.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.8,40,,63.04,percent of total billed charges,40% of total billed charges,26.32,157.6,
DRUG TEST PRES ANY#,7000029,CDM,301,RC,80307,HCPCS,Outpatient,,,113,90.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,46.61,75,,,fee schedule,75% of CMS fee schedule,46.61,75,,,fee schedule,75% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,46.61,75,,,fee schedule,75% of CMS fee schedule,46.61,75,,,fee schedule,75% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.2,40,,36.16,percent of total billed charges,40% of total billed charges,42.12,90.4,
HELIBACT PYL STL AGN,7000284,CDM,306,RC,87338,HCPCS,Outpatient,,,181,144.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,10.79,75,,,fee schedule,75% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,14.38,100,,,fee schedule,100% of CMS fee schedule,14.38,100,,,fee schedule,100% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,14.38,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.4,40,,57.92,percent of total billed charges,40% of total billed charges,10.79,144.8,
"CRP, CARDIAC",7000169,CDM,302,RC,86141,HCPCS,Outpatient,,,115,92.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,9.71,75,,,fee schedule,75% of CMS fee schedule,9.71,75,,,fee schedule,75% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,9.71,75,,,fee schedule,75% of CMS fee schedule,9.71,75,,,fee schedule,75% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46,40,,36.8,percent of total billed charges,40% of total billed charges,9.71,92,
RENAL FUNCTION PANEL,7000029,CDM,301,RC,80069,HCPCS,Outpatient,,,62,49.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,6.51,75,,,fee schedule,75% of CMS fee schedule,6.51,75,,,fee schedule,75% of CMS fee schedule,8.68,100,,,fee schedule,100% of CMS fee schedule,8.68,100,,,fee schedule,100% of CMS fee schedule,6.51,75,,,fee schedule,75% of CMS fee schedule,6.51,75,,,fee schedule,75% of CMS fee schedule,8.68,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,40,,19.84,percent of total billed charges,40% of total billed charges,6.51,49.6,
NEURONTIN,7000029,CDM,301,RC,80171,HCPCS,Outpatient,,,144,115.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,16.25,75,,,fee schedule,75% of CMS fee schedule,16.25,75,,,fee schedule,75% of CMS fee schedule,21.67,100,,,fee schedule,100% of CMS fee schedule,21.67,100,,,fee schedule,100% of CMS fee schedule,16.25,75,,,fee schedule,75% of CMS fee schedule,16.25,75,,,fee schedule,75% of CMS fee schedule,21.67,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,40,,46.08,percent of total billed charges,40% of total billed charges,16.25,115.2,
ALLOPURINOL (ZYLOPRI,7000029,CDM,301,RC,80299,HCPCS,Outpatient,,,174,139.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,64.85,37.27,,51.88,percent of total billed charges,37.27% of total billed charges,64.85,37.27,,51.88,percent of total billed charges,37.27% of total billed charges,64.85,37.27,,51.88,percent of total billed charges,37.27% of total billed charges,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,40,,55.68,percent of total billed charges,40% of total billed charges,13.98,139.2,
CALCIUM URINE RAMDOM,7000029,CDM,301,RC,82340,HCPCS,Outpatient,,,38,30.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,4.52,75,,,fee schedule,75% of CMS fee schedule,4.52,75,,,fee schedule,75% of CMS fee schedule,6.03,100,,,fee schedule,100% of CMS fee schedule,6.03,100,,,fee schedule,100% of CMS fee schedule,4.52,75,,,fee schedule,75% of CMS fee schedule,4.52,75,,,fee schedule,75% of CMS fee schedule,6.03,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,4.52,30.4,
GIARDIA SPECIFIC ANT,7000284,CDM,306,RC,87329,HCPCS,Outpatient,,,122,97.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,8.99,75,,,fee schedule,75% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.8,40,,39.04,percent of total billed charges,40% of total billed charges,8.99,97.6,
REPTILASE,7000177,CDM,305,RC,85635,HCPCS,Outpatient,,,252,201.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,80,,161.28,percent of total billed charges,80% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,7.39,75,,,fee schedule,75% of CMS fee schedule,7.39,75,,,fee schedule,75% of CMS fee schedule,9.85,100,,,fee schedule,100% of CMS fee schedule,9.85,100,,,fee schedule,100% of CMS fee schedule,7.39,75,,,fee schedule,75% of CMS fee schedule,7.39,75,,,fee schedule,75% of CMS fee schedule,9.85,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,40,,80.64,percent of total billed charges,40% of total billed charges,7.39,201.6,
HEPATITIS C GENOTYPE,7000284,CDM,306,RC,87902,HCPCS,Outpatient,,,1442,1153.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1153.6,80,,922.88,percent of total billed charges,80% of total billed charges,537.43,37.27,,429.94,percent of total billed charges,37.27% of total billed charges,537.43,37.27,,429.94,percent of total billed charges,37.27% of total billed charges,537.43,37.27,,429.94,percent of total billed charges,37.27% of total billed charges,193.09,75,,,fee schedule,75% of CMS fee schedule,193.09,75,,,fee schedule,75% of CMS fee schedule,257.45,100,,,fee schedule,100% of CMS fee schedule,257.45,100,,,fee schedule,100% of CMS fee schedule,193.09,75,,,fee schedule,75% of CMS fee schedule,193.09,75,,,fee schedule,75% of CMS fee schedule,257.45,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576.8,40,,461.44,percent of total billed charges,40% of total billed charges,193.09,1153.6,
LAMICTOL LEVEL,7000029,CDM,301,RC,80175,HCPCS,Outpatient,,,60,48.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,9.94,75,,,fee schedule,75% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,40,,19.2,percent of total billed charges,40% of total billed charges,9.94,48,
"WBC, STOOL",7000177,CDM,305,RC,89055,HCPCS,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,3.2,11.2,
DRUG 1-7 DEFINITIVE,7012032,CDM,300,RC,G0480,HCPCS,Outpatient,,,278,222.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.4,80,,177.92,percent of total billed charges,80% of total billed charges,103.61,37.27,,82.89,percent of total billed charges,37.27% of total billed charges,103.61,37.27,,82.89,percent of total billed charges,37.27% of total billed charges,103.61,37.27,,82.89,percent of total billed charges,37.27% of total billed charges,85.82,75,,,fee schedule,75% of CMS fee schedule,85.82,75,,,fee schedule,75% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,85.82,75,,,fee schedule,75% of CMS fee schedule,85.82,75,,,fee schedule,75% of CMS fee schedule,114.43,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.2,40,,88.96,percent of total billed charges,40% of total billed charges,85.82,222.4,
LIPOPROTEIN A,7000029,CDM,301,RC,83695,HCPCS,Outpatient,,,94,75.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,10.74,75,,,fee schedule,75% of CMS fee schedule,10.74,75,,,fee schedule,75% of CMS fee schedule,14.32,100,,,fee schedule,100% of CMS fee schedule,14.32,100,,,fee schedule,100% of CMS fee schedule,10.74,75,,,fee schedule,75% of CMS fee schedule,10.74,75,,,fee schedule,75% of CMS fee schedule,14.32,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,10.74,75.2,
"COMPLEMENT, C2",7000169,CDM,302,RC,86160,HCPCS,Outpatient,,,88,70.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,9,75,,,fee schedule,75% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,40,,28.16,percent of total billed charges,40% of total billed charges,9,70.4,
ANTITHYROID PEROXIDA,7000169,CDM,302,RC,86376,HCPCS,Outpatient,,,97,77.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,10.91,75,,,fee schedule,75% of CMS fee schedule,10.91,75,,,fee schedule,75% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,10.91,75,,,fee schedule,75% of CMS fee schedule,10.91,75,,,fee schedule,75% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.8,40,,31.04,percent of total billed charges,40% of total billed charges,10.91,77.6,
THYROGLOBULIN,7000029,CDM,301,RC,84432,HCPCS,Outpatient,,,129,103.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,48.08,37.27,,38.46,percent of total billed charges,37.27% of total billed charges,48.08,37.27,,38.46,percent of total billed charges,37.27% of total billed charges,48.08,37.27,,38.46,percent of total billed charges,37.27% of total billed charges,12.05,75,,,fee schedule,75% of CMS fee schedule,12.05,75,,,fee schedule,75% of CMS fee schedule,16.06,100,,,fee schedule,100% of CMS fee schedule,16.06,100,,,fee schedule,100% of CMS fee schedule,12.05,75,,,fee schedule,75% of CMS fee schedule,12.05,75,,,fee schedule,75% of CMS fee schedule,16.06,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.6,40,,41.28,percent of total billed charges,40% of total billed charges,12.05,103.2,
BASIC METABOL PANEL,7000029,CDM,301,RC,80048,HCPCS,Outpatient,,,39.87,31.90,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.9,80,,25.52,percent of total billed charges,80% of total billed charges,14.86,37.27,,11.89,percent of total billed charges,37.27% of total billed charges,14.86,37.27,,11.89,percent of total billed charges,37.27% of total billed charges,14.86,37.27,,11.89,percent of total billed charges,37.27% of total billed charges,6.35,75,,,fee schedule,75% of CMS fee schedule,6.35,75,,,fee schedule,75% of CMS fee schedule,8.46,100,,,fee schedule,100% of CMS fee schedule,8.46,100,,,fee schedule,100% of CMS fee schedule,6.35,75,,,fee schedule,75% of CMS fee schedule,6.35,75,,,fee schedule,75% of CMS fee schedule,8.46,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.95,40,,12.76,percent of total billed charges,40% of total billed charges,6.35,31.9,
ABG ANALYSIS,7000029,CDM,301,RC,82803,HCPCS,Outpatient,,,168,134.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,19.55,75,,,fee schedule,75% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,40,,53.76,percent of total billed charges,40% of total billed charges,19.55,134.4,
PROTEIN URINE,7000029,CDM,301,RC,84156,HCPCS,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,2.75,75,,,fee schedule,75% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,2.75,21.6,
COMP METAB PANEL,7000029,CDM,301,RC,80053,HCPCS,Outpatient,,,151,120.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% of total billed charges,7.92,75,,,fee schedule,75% of CMS fee schedule,7.92,75,,,fee schedule,75% of CMS fee schedule,10.56,100,,,fee schedule,100% of CMS fee schedule,10.56,100,,,fee schedule,100% of CMS fee schedule,7.92,75,,,fee schedule,75% of CMS fee schedule,7.92,75,,,fee schedule,75% of CMS fee schedule,10.56,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.4,40,,48.32,percent of total billed charges,40% of total billed charges,7.92,120.8,
MTHFR-METHYLENET DNA,7000029,CDM,301,RC,81291,HCPCS,Outpatient,,,171,136.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,63.73,37.27,,50.98,percent of total billed charges,37.27% of total billed charges,63.73,37.27,,50.98,percent of total billed charges,37.27% of total billed charges,63.73,37.27,,50.98,percent of total billed charges,37.27% of total billed charges,49.01,75,,,fee schedule,75% of CMS fee schedule,49.01,75,,,fee schedule,75% of CMS fee schedule,65.34,100,,,fee schedule,100% of CMS fee schedule,65.34,100,,,fee schedule,100% of CMS fee schedule,49.01,75,,,fee schedule,75% of CMS fee schedule,49.01,75,,,fee schedule,75% of CMS fee schedule,65.34,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.4,40,,54.72,percent of total billed charges,40% of total billed charges,49.01,136.8,
ZINC LEVEL,7000029,CDM,301,RC,84630,HCPCS,Outpatient,,,94.13,75.30,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.3,80,,60.24,percent of total billed charges,80% of total billed charges,35.08,37.27,,28.06,percent of total billed charges,37.27% of total billed charges,35.08,37.27,,28.06,percent of total billed charges,37.27% of total billed charges,35.08,37.27,,28.06,percent of total billed charges,37.27% of total billed charges,8.54,75,,,fee schedule,75% of CMS fee schedule,8.54,75,,,fee schedule,75% of CMS fee schedule,11.39,100,,,fee schedule,100% of CMS fee schedule,11.39,100,,,fee schedule,100% of CMS fee schedule,8.54,75,,,fee schedule,75% of CMS fee schedule,8.54,75,,,fee schedule,75% of CMS fee schedule,11.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.65,40,,30.12,percent of total billed charges,40% of total billed charges,8.54,75.3,
FACTOR XII,7000177,CDM,305,RC,85280,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,14.51,75,,,fee schedule,75% of CMS fee schedule,14.51,75,,,fee schedule,75% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,14.51,75,,,fee schedule,75% of CMS fee schedule,14.51,75,,,fee schedule,75% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,14.51,128,
ESTRIOL,7000029,CDM,301,RC,82677,HCPCS,Outpatient,,,136,108.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,18.14,75,,,fee schedule,75% of CMS fee schedule,18.14,75,,,fee schedule,75% of CMS fee schedule,24.18,100,,,fee schedule,100% of CMS fee schedule,24.18,100,,,fee schedule,100% of CMS fee schedule,18.14,75,,,fee schedule,75% of CMS fee schedule,18.14,75,,,fee schedule,75% of CMS fee schedule,24.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,18.14,108.8,
"HEMOGLOBIN, FREE",7000029,CDM,301,RC,83051,HCPCS,Outpatient,,,80,64.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,5.48,75,,,fee schedule,75% of CMS fee schedule,5.48,75,,,fee schedule,75% of CMS fee schedule,7.31,100,,,fee schedule,100% of CMS fee schedule,7.31,100,,,fee schedule,100% of CMS fee schedule,5.48,75,,,fee schedule,75% of CMS fee schedule,5.48,75,,,fee schedule,75% of CMS fee schedule,7.31,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,40,,25.6,percent of total billed charges,40% of total billed charges,5.48,64,
"HLA-DR, DQ PHENOTYPE",7000169,CDM,302,RC,86817,HCPCS,Outpatient,,,720,576.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,79.61,75,,,fee schedule,75% of CMS fee schedule,79.61,75,,,fee schedule,75% of CMS fee schedule,106.14,100,,,fee schedule,100% of CMS fee schedule,106.14,100,,,fee schedule,100% of CMS fee schedule,79.61,75,,,fee schedule,75% of CMS fee schedule,79.61,75,,,fee schedule,75% of CMS fee schedule,106.14,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,40,,230.4,percent of total billed charges,40% of total billed charges,79.61,576,
"HLA-A,B,C PHENOTYPE",7000169,CDM,302,RC,86813,HCPCS,Outpatient,,,816,652.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,652.8,80,,522.24,percent of total billed charges,80% of total billed charges,304.12,37.27,,243.3,percent of total billed charges,37.27% of total billed charges,304.12,37.27,,243.3,percent of total billed charges,37.27% of total billed charges,304.12,37.27,,243.3,percent of total billed charges,37.27% of total billed charges,43.5,75,,,fee schedule,75% of CMS fee schedule,43.5,75,,,fee schedule,75% of CMS fee schedule,58,100,,,fee schedule,100% of CMS fee schedule,58,100,,,fee schedule,100% of CMS fee schedule,43.5,75,,,fee schedule,75% of CMS fee schedule,43.5,75,,,fee schedule,75% of CMS fee schedule,58,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,326.4,40,,261.12,percent of total billed charges,40% of total billed charges,43.5,652.8,
METHYLMALONIC ACID,7000029,CDM,301,RC,83921,HCPCS,Outpatient,,,92,73.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,15.91,75,,,fee schedule,75% of CMS fee schedule,15.91,75,,,fee schedule,75% of CMS fee schedule,21.21,100,,,fee schedule,100% of CMS fee schedule,21.21,100,,,fee schedule,100% of CMS fee schedule,15.91,75,,,fee schedule,75% of CMS fee schedule,15.91,75,,,fee schedule,75% of CMS fee schedule,21.21,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,40,,29.44,percent of total billed charges,40% of total billed charges,15.91,73.6,
FACTOR XIII FUNCTION,7000177,CDM,305,RC,85290,HCPCS,Outpatient,,,242,193.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.6,80,,154.88,percent of total billed charges,80% of total billed charges,90.19,37.27,,72.15,percent of total billed charges,37.27% of total billed charges,90.19,37.27,,72.15,percent of total billed charges,37.27% of total billed charges,90.19,37.27,,72.15,percent of total billed charges,37.27% of total billed charges,12.26,75,,,fee schedule,75% of CMS fee schedule,12.26,75,,,fee schedule,75% of CMS fee schedule,16.34,100,,,fee schedule,100% of CMS fee schedule,16.34,100,,,fee schedule,100% of CMS fee schedule,12.26,75,,,fee schedule,75% of CMS fee schedule,12.26,75,,,fee schedule,75% of CMS fee schedule,16.34,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.8,40,,77.44,percent of total billed charges,40% of total billed charges,12.26,193.6,
"PLATELET ANTIBDY,IND",7000169,CDM,302,RC,86023,HCPCS,Outpatient,,,283,226.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% of total billed charges,9.35,75,,,fee schedule,75% of CMS fee schedule,9.35,75,,,fee schedule,75% of CMS fee schedule,12.46,100,,,fee schedule,100% of CMS fee schedule,12.46,100,,,fee schedule,100% of CMS fee schedule,9.35,75,,,fee schedule,75% of CMS fee schedule,9.35,75,,,fee schedule,75% of CMS fee schedule,12.46,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.2,40,,90.56,percent of total billed charges,40% of total billed charges,9.35,226.4,
"TYPHUS FEVER AB, IGG",7000169,CDM,302,RC,86757,HCPCS,Outpatient,,,76,60.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,14.51,75,,,fee schedule,75% of CMS fee schedule,14.51,75,,,fee schedule,75% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,14.51,75,,,fee schedule,75% of CMS fee schedule,14.51,75,,,fee schedule,75% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,40,,24.32,percent of total billed charges,40% of total billed charges,14.51,60.8,
HERED HEMO DNA PANEL,7000029,CDM,301,RC,81256,HCPCS,Outpatient,,,202,161.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,75.29,37.27,,60.23,percent of total billed charges,37.27% of total billed charges,75.29,37.27,,60.23,percent of total billed charges,37.27% of total billed charges,75.29,37.27,,60.23,percent of total billed charges,37.27% of total billed charges,49.02,75,,,fee schedule,75% of CMS fee schedule,49.02,75,,,fee schedule,75% of CMS fee schedule,65.36,100,,,fee schedule,100% of CMS fee schedule,65.36,100,,,fee schedule,100% of CMS fee schedule,49.02,75,,,fee schedule,75% of CMS fee schedule,49.02,75,,,fee schedule,75% of CMS fee schedule,65.36,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.8,40,,64.64,percent of total billed charges,40% of total billed charges,49.02,161.6,
ALPHA1 ANTITRYP PHEN,7000029,CDM,301,RC,82104,HCPCS,Outpatient,,,64.52,51.62,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.62,80,,41.3,percent of total billed charges,80% of total billed charges,24.05,37.27,,19.24,percent of total billed charges,37.27% of total billed charges,24.05,37.27,,19.24,percent of total billed charges,37.27% of total billed charges,24.05,37.27,,19.24,percent of total billed charges,37.27% of total billed charges,10.85,75,,,fee schedule,75% of CMS fee schedule,10.85,75,,,fee schedule,75% of CMS fee schedule,14.46,100,,,fee schedule,100% of CMS fee schedule,14.46,100,,,fee schedule,100% of CMS fee schedule,10.85,75,,,fee schedule,75% of CMS fee schedule,10.85,75,,,fee schedule,75% of CMS fee schedule,14.46,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.81,40,,20.65,percent of total billed charges,40% of total billed charges,10.85,51.62,
FUNGUS CULTR-BLOOD,7000284,CDM,306,RC,87103,HCPCS,Outpatient,,,66,52.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,15.35,75,,,fee schedule,75% of CMS fee schedule,15.35,75,,,fee schedule,75% of CMS fee schedule,20.46,100,,,fee schedule,100% of CMS fee schedule,20.46,100,,,fee schedule,100% of CMS fee schedule,15.35,75,,,fee schedule,75% of CMS fee schedule,15.35,75,,,fee schedule,75% of CMS fee schedule,20.46,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,15.35,52.8,
"FUNGUS CULTR-SK,HR,N",7000284,CDM,306,RC,87101,HCPCS,Outpatient,,,66,52.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,5.78,75,,,fee schedule,75% of CMS fee schedule,5.78,75,,,fee schedule,75% of CMS fee schedule,7.71,100,,,fee schedule,100% of CMS fee schedule,7.71,100,,,fee schedule,100% of CMS fee schedule,5.78,75,,,fee schedule,75% of CMS fee schedule,5.78,75,,,fee schedule,75% of CMS fee schedule,7.71,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,5.78,52.8,
INSULIN AUTOANTIBODY,7000169,CDM,302,RC,86337,HCPCS,Outpatient,,,251,200.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,93.55,37.27,,74.84,percent of total billed charges,37.27% of total billed charges,93.55,37.27,,74.84,percent of total billed charges,37.27% of total billed charges,93.55,37.27,,74.84,percent of total billed charges,37.27% of total billed charges,16.06,75,,,fee schedule,75% of CMS fee schedule,16.06,75,,,fee schedule,75% of CMS fee schedule,21.41,100,,,fee schedule,100% of CMS fee schedule,21.41,100,,,fee schedule,100% of CMS fee schedule,16.06,75,,,fee schedule,75% of CMS fee schedule,16.06,75,,,fee schedule,75% of CMS fee schedule,21.41,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.4,40,,80.32,percent of total billed charges,40% of total billed charges,16.06,200.8,
LYMES TITER PCR DNA,7000284,CDM,306,RC,87476,HCPCS,Outpatient,,,203,162.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.2,40,,64.96,percent of total billed charges,40% of total billed charges,26.32,162.4,
FACTOR V LEIDEN MUTA,7000029,CDM,301,RC,81241,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,55.03,75,,,fee schedule,75% of CMS fee schedule,55.03,75,,,fee schedule,75% of CMS fee schedule,73.37,100,,,fee schedule,100% of CMS fee schedule,73.37,100,,,fee schedule,100% of CMS fee schedule,55.03,75,,,fee schedule,75% of CMS fee schedule,55.03,75,,,fee schedule,75% of CMS fee schedule,73.37,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.03,73.37,
RBC,7000177,CDM,305,RC,85041,HCPCS,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,2.27,75,,,fee schedule,75% of CMS fee schedule,2.27,75,,,fee schedule,75% of CMS fee schedule,3.02,100,,,fee schedule,100% of CMS fee schedule,3.02,100,,,fee schedule,100% of CMS fee schedule,2.27,75,,,fee schedule,75% of CMS fee schedule,2.27,75,,,fee schedule,75% of CMS fee schedule,3.02,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,2.27,13.6,
CLONIDINE LEVEL,7000029,CDM,301,RC,80299,HCPCS,Outpatient,,,283,226.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% of total billed charges,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.2,40,,90.56,percent of total billed charges,40% of total billed charges,13.98,226.4,
HSV 1 SPECIFIC IGG,7000169,CDM,302,RC,86695,HCPCS,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,9.89,75,,,fee schedule,75% of CMS fee schedule,9.89,75,,,fee schedule,75% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,9.89,75,,,fee schedule,75% of CMS fee schedule,9.89,75,,,fee schedule,75% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,9.89,59.2,
CD4/CD8 ABSOLUTE CT,7000169,CDM,302,RC,86360,HCPCS,Outpatient,,,225,180.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,80,,144,percent of total billed charges,80% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,35.24,75,,,fee schedule,75% of CMS fee schedule,35.24,75,,,fee schedule,75% of CMS fee schedule,46.98,100,,,fee schedule,100% of CMS fee schedule,46.98,100,,,fee schedule,100% of CMS fee schedule,35.24,75,,,fee schedule,75% of CMS fee schedule,35.24,75,,,fee schedule,75% of CMS fee schedule,46.98,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90,40,,72,percent of total billed charges,40% of total billed charges,35.24,180,
T CELL LYMPHOCYTE CO,7000169,CDM,302,RC,86359,HCPCS,Outpatient,,,225,180.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,80,,144,percent of total billed charges,80% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,28.3,75,,,fee schedule,75% of CMS fee schedule,28.3,75,,,fee schedule,75% of CMS fee schedule,37.73,100,,,fee schedule,100% of CMS fee schedule,37.73,100,,,fee schedule,100% of CMS fee schedule,28.3,75,,,fee schedule,75% of CMS fee schedule,28.3,75,,,fee schedule,75% of CMS fee schedule,37.73,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90,40,,72,percent of total billed charges,40% of total billed charges,28.3,180,
FACTOR IX,7000177,CDM,305,RC,85250,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,14.28,75,,,fee schedule,75% of CMS fee schedule,14.28,75,,,fee schedule,75% of CMS fee schedule,19.04,100,,,fee schedule,100% of CMS fee schedule,19.04,100,,,fee schedule,100% of CMS fee schedule,14.28,75,,,fee schedule,75% of CMS fee schedule,14.28,75,,,fee schedule,75% of CMS fee schedule,19.04,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,14.28,128,
SUSCEPTIBILITY DISK,7000284,CDM,306,RC,87184,HCPCS,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,5.61,75,,,fee schedule,75% of CMS fee schedule,5.61,75,,,fee schedule,75% of CMS fee schedule,7.48,100,,,fee schedule,100% of CMS fee schedule,7.48,100,,,fee schedule,100% of CMS fee schedule,5.61,75,,,fee schedule,75% of CMS fee schedule,5.61,75,,,fee schedule,75% of CMS fee schedule,7.48,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,5.61,31.2,
B LACTAMASE ENZY DET,7000284,CDM,306,RC,87185,HCPCS,Outpatient,,,27,21.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,3.56,75,,,fee schedule,75% of CMS fee schedule,3.56,75,,,fee schedule,75% of CMS fee schedule,4.75,100,,,fee schedule,100% of CMS fee schedule,4.75,100,,,fee schedule,100% of CMS fee schedule,3.56,75,,,fee schedule,75% of CMS fee schedule,3.56,75,,,fee schedule,75% of CMS fee schedule,4.75,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,3.56,21.6,
CYTOMEGALOVIRUS CULT,7000284,CDM,306,RC,87252,HCPCS,Outpatient,,,146,116.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,19.55,75,,,fee schedule,75% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,19.55,116.8,
IMMUNOFLOR STAIN CUL,7000284,CDM,306,RC,87254,HCPCS,Outpatient,,,27,21.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,14.67,75,,,fee schedule,75% of CMS fee schedule,14.67,75,,,fee schedule,75% of CMS fee schedule,19.56,100,,,fee schedule,100% of CMS fee schedule,19.56,100,,,fee schedule,100% of CMS fee schedule,14.67,75,,,fee schedule,75% of CMS fee schedule,14.67,75,,,fee schedule,75% of CMS fee schedule,19.56,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,10.06,21.6,
FACTOR II,7000029,CDM,301,RC,81240,HCPCS,Outpatient,,,202,161.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,75.29,37.27,,60.23,percent of total billed charges,37.27% of total billed charges,75.29,37.27,,60.23,percent of total billed charges,37.27% of total billed charges,75.29,37.27,,60.23,percent of total billed charges,37.27% of total billed charges,49.27,75,,,fee schedule,75% of CMS fee schedule,49.27,75,,,fee schedule,75% of CMS fee schedule,65.69,100,,,fee schedule,100% of CMS fee schedule,65.69,100,,,fee schedule,100% of CMS fee schedule,49.27,75,,,fee schedule,75% of CMS fee schedule,49.27,75,,,fee schedule,75% of CMS fee schedule,65.69,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.8,40,,64.64,percent of total billed charges,40% of total billed charges,49.27,161.6,
T-TRANSGLUTAMINASE I,7000029,CDM,301,RC,83516,HCPCS,Outpatient,,,34,27.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,8.65,27.2,
CYSTINE URINE QUANT,7000029,CDM,301,RC,82131,HCPCS,Outpatient,,,181,144.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,17.24,75,,,fee schedule,75% of CMS fee schedule,17.24,75,,,fee schedule,75% of CMS fee schedule,22.98,100,,,fee schedule,100% of CMS fee schedule,22.98,100,,,fee schedule,100% of CMS fee schedule,17.24,75,,,fee schedule,75% of CMS fee schedule,17.24,75,,,fee schedule,75% of CMS fee schedule,22.98,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.4,40,,57.92,percent of total billed charges,40% of total billed charges,17.24,144.8,
CYCLOSPORINE LEVEL,7000029,CDM,301,RC,80158,HCPCS,Outpatient,,,101,80.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,13.54,75,,,fee schedule,75% of CMS fee schedule,13.54,75,,,fee schedule,75% of CMS fee schedule,18.05,100,,,fee schedule,100% of CMS fee schedule,18.05,100,,,fee schedule,100% of CMS fee schedule,13.54,75,,,fee schedule,75% of CMS fee schedule,13.54,75,,,fee schedule,75% of CMS fee schedule,18.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.4,40,,32.32,percent of total billed charges,40% of total billed charges,13.54,80.8,
CITRATE,7000029,CDM,301,RC,82507,HCPCS,Outpatient,,,155,124.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,20.85,75,,,fee schedule,75% of CMS fee schedule,20.85,75,,,fee schedule,75% of CMS fee schedule,27.8,100,,,fee schedule,100% of CMS fee schedule,27.8,100,,,fee schedule,100% of CMS fee schedule,20.85,75,,,fee schedule,75% of CMS fee schedule,20.85,75,,,fee schedule,75% of CMS fee schedule,27.8,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62,40,,49.6,percent of total billed charges,40% of total billed charges,20.85,124,
"VIT D1, 25-DIHYDROXY",7000029,CDM,301,RC,82652,HCPCS,Outpatient,,,216,172.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,80.5,37.27,,64.4,percent of total billed charges,37.27% of total billed charges,80.5,37.27,,64.4,percent of total billed charges,37.27% of total billed charges,80.5,37.27,,64.4,percent of total billed charges,37.27% of total billed charges,28.88,75,,,fee schedule,75% of CMS fee schedule,28.88,75,,,fee schedule,75% of CMS fee schedule,38.5,100,,,fee schedule,100% of CMS fee schedule,38.5,100,,,fee schedule,100% of CMS fee schedule,28.88,75,,,fee schedule,75% of CMS fee schedule,28.88,75,,,fee schedule,75% of CMS fee schedule,38.5,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,40,,69.12,percent of total billed charges,40% of total billed charges,28.88,172.8,
"HEPATITIS A AB, IGM",7000169,CDM,302,RC,86709,HCPCS,Outpatient,,,63,50.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,8.45,75,,,fee schedule,75% of CMS fee schedule,8.45,75,,,fee schedule,75% of CMS fee schedule,11.26,100,,,fee schedule,100% of CMS fee schedule,11.26,100,,,fee schedule,100% of CMS fee schedule,8.45,75,,,fee schedule,75% of CMS fee schedule,8.45,75,,,fee schedule,75% of CMS fee schedule,11.26,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,40,,20.16,percent of total billed charges,40% of total billed charges,8.45,50.4,
GLUCOSE TOL ADD HOUR,7000029,CDM,301,RC,82952,HCPCS,Outpatient,,,21,16.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,2.94,75,,,fee schedule,75% of CMS fee schedule,2.94,75,,,fee schedule,75% of CMS fee schedule,3.92,100,,,fee schedule,100% of CMS fee schedule,3.92,100,,,fee schedule,100% of CMS fee schedule,2.94,75,,,fee schedule,75% of CMS fee schedule,2.94,75,,,fee schedule,75% of CMS fee schedule,3.92,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,2.94,16.8,
VON WILLEBRAND FACTO,7000177,CDM,305,RC,85245,HCPCS,Outpatient,,,120,96.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,17.21,75,,,fee schedule,75% of CMS fee schedule,17.21,75,,,fee schedule,75% of CMS fee schedule,22.94,100,,,fee schedule,100% of CMS fee schedule,22.94,100,,,fee schedule,100% of CMS fee schedule,17.21,75,,,fee schedule,75% of CMS fee schedule,17.21,75,,,fee schedule,75% of CMS fee schedule,22.94,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,40,,38.4,percent of total billed charges,40% of total billed charges,17.21,96,
ISOHEMAGGLUTIN TITER,7000169,CDM,302,RC,86940,HCPCS,Outpatient,,,95,76.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,6.58,75,,,fee schedule,75% of CMS fee schedule,6.58,75,,,fee schedule,75% of CMS fee schedule,8.77,100,,,fee schedule,100% of CMS fee schedule,8.77,100,,,fee schedule,100% of CMS fee schedule,6.58,75,,,fee schedule,75% of CMS fee schedule,6.58,75,,,fee schedule,75% of CMS fee schedule,8.77,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38,40,,30.4,percent of total billed charges,40% of total billed charges,6.58,76,
EBV EARLY ANTIG IGG,7000169,CDM,302,RC,86663,HCPCS,Outpatient,,,60,48.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,9.84,75,,,fee schedule,75% of CMS fee schedule,9.84,75,,,fee schedule,75% of CMS fee schedule,13.12,100,,,fee schedule,100% of CMS fee schedule,13.12,100,,,fee schedule,100% of CMS fee schedule,9.84,75,,,fee schedule,75% of CMS fee schedule,9.84,75,,,fee schedule,75% of CMS fee schedule,13.12,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,40,,19.2,percent of total billed charges,40% of total billed charges,9.84,48,
PSA COMPLEXED,7000029,CDM,301,RC,84152,HCPCS,Outpatient,,,134,107.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,13.79,75,,,fee schedule,75% of CMS fee schedule,13.79,75,,,fee schedule,75% of CMS fee schedule,18.39,100,,,fee schedule,100% of CMS fee schedule,18.39,100,,,fee schedule,100% of CMS fee schedule,13.79,75,,,fee schedule,75% of CMS fee schedule,13.79,75,,,fee schedule,75% of CMS fee schedule,18.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,40,,42.88,percent of total billed charges,40% of total billed charges,13.79,107.2,
"WEST NILE, CSF,PCR",7000284,CDM,306,RC,87798,HCPCS,Outpatient,,,239,191.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.6,40,,76.48,percent of total billed charges,40% of total billed charges,26.32,191.2,
ISLET CELL ANITBODY,7000169,CDM,302,RC,86341,HCPCS,Outpatient,,,112,89.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,17.68,75,,,fee schedule,75% of CMS fee schedule,17.68,75,,,fee schedule,75% of CMS fee schedule,23.57,100,,,fee schedule,100% of CMS fee schedule,23.57,100,,,fee schedule,100% of CMS fee schedule,17.68,75,,,fee schedule,75% of CMS fee schedule,17.68,75,,,fee schedule,75% of CMS fee schedule,23.57,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,40,,35.84,percent of total billed charges,40% of total billed charges,17.68,89.6,
RPR QUANTITATIVE,7000169,CDM,302,RC,86593,HCPCS,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,3.3,75,,,fee schedule,75% of CMS fee schedule,3.3,75,,,fee schedule,75% of CMS fee schedule,4.4,100,,,fee schedule,100% of CMS fee schedule,4.4,100,,,fee schedule,100% of CMS fee schedule,3.3,75,,,fee schedule,75% of CMS fee schedule,3.3,75,,,fee schedule,75% of CMS fee schedule,4.4,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,3.3,19.2,
"IGG,IGA,IGM",7000029,CDM,301,RC,82784,HCPCS,Outpatient,,,53,42.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,6.98,75,,,fee schedule,75% of CMS fee schedule,6.98,75,,,fee schedule,75% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,6.98,75,,,fee schedule,75% of CMS fee schedule,6.98,75,,,fee schedule,75% of CMS fee schedule,9.3,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,6.98,42.4,
OLIGOCLONAL SER& CSF,7000029,CDM,301,RC,83916,HCPCS,Outpatient,,,116,92.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,20.54,75,,,fee schedule,75% of CMS fee schedule,20.54,75,,,fee schedule,75% of CMS fee schedule,27.39,100,,,fee schedule,100% of CMS fee schedule,27.39,100,,,fee schedule,100% of CMS fee schedule,20.54,75,,,fee schedule,75% of CMS fee schedule,20.54,75,,,fee schedule,75% of CMS fee schedule,27.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,40,,37.12,percent of total billed charges,40% of total billed charges,20.54,92.8,
VITAMIN E,7000029,CDM,301,RC,84446,HCPCS,Outpatient,,,84,67.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,80,,53.76,percent of total billed charges,80% of total billed charges,31.31,37.27,,25.05,percent of total billed charges,37.27% of total billed charges,31.31,37.27,,25.05,percent of total billed charges,37.27% of total billed charges,31.31,37.27,,25.05,percent of total billed charges,37.27% of total billed charges,10.64,75,,,fee schedule,75% of CMS fee schedule,10.64,75,,,fee schedule,75% of CMS fee schedule,14.18,100,,,fee schedule,100% of CMS fee schedule,14.18,100,,,fee schedule,100% of CMS fee schedule,10.64,75,,,fee schedule,75% of CMS fee schedule,10.64,75,,,fee schedule,75% of CMS fee schedule,14.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,40,,26.88,percent of total billed charges,40% of total billed charges,10.64,67.2,
VITAMIN B1,7000029,CDM,301,RC,84425,HCPCS,Outpatient,,,90,72.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,15.92,75,,,fee schedule,75% of CMS fee schedule,15.92,75,,,fee schedule,75% of CMS fee schedule,21.23,100,,,fee schedule,100% of CMS fee schedule,21.23,100,,,fee schedule,100% of CMS fee schedule,15.92,75,,,fee schedule,75% of CMS fee schedule,15.92,75,,,fee schedule,75% of CMS fee schedule,21.23,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,40,,28.8,percent of total billed charges,40% of total billed charges,15.92,72,
VITAMIN B6,7000029,CDM,301,RC,84207,HCPCS,Outpatient,,,80,64.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,21.08,75,,,fee schedule,75% of CMS fee schedule,21.08,75,,,fee schedule,75% of CMS fee schedule,28.1,100,,,fee schedule,100% of CMS fee schedule,28.1,100,,,fee schedule,100% of CMS fee schedule,21.08,75,,,fee schedule,75% of CMS fee schedule,21.08,75,,,fee schedule,75% of CMS fee schedule,28.1,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,40,,25.6,percent of total billed charges,40% of total billed charges,21.08,64,
HISTAMINE URINE,7000029,CDM,301,RC,83088,HCPCS,Outpatient,,,200,160.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160,80,,128,percent of total billed charges,80% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,22.15,75,,,fee schedule,75% of CMS fee schedule,22.15,75,,,fee schedule,75% of CMS fee schedule,29.53,100,,,fee schedule,100% of CMS fee schedule,29.53,100,,,fee schedule,100% of CMS fee schedule,22.15,75,,,fee schedule,75% of CMS fee schedule,22.15,75,,,fee schedule,75% of CMS fee schedule,29.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,40,,64,percent of total billed charges,40% of total billed charges,22.15,160,
TIAGABINE (GABILEIL),7000029,CDM,301,RC,80199,HCPCS,Outpatient,,,172,137.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% of total billed charges,20.33,75,,,fee schedule,75% of CMS fee schedule,20.33,75,,,fee schedule,75% of CMS fee schedule,27.11,100,,,fee schedule,100% of CMS fee schedule,27.11,100,,,fee schedule,100% of CMS fee schedule,20.33,75,,,fee schedule,75% of CMS fee schedule,20.33,75,,,fee schedule,75% of CMS fee schedule,27.11,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.8,40,,55.04,percent of total billed charges,40% of total billed charges,20.33,137.6,
T CELL GENE REARRANG,7000268,CDM,310,RC,81341,HCPCS,Outpatient,,,426,340.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,340.8,80,,272.64,percent of total billed charges,80% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% of total billed charges,37.19,75,,,fee schedule,75% of CMS fee schedule,37.19,75,,,fee schedule,75% of CMS fee schedule,49.59,100,,,fee schedule,100% of CMS fee schedule,49.59,100,,,fee schedule,100% of CMS fee schedule,37.19,75,,,fee schedule,75% of CMS fee schedule,37.19,75,,,fee schedule,75% of CMS fee schedule,49.59,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170.4,40,,136.32,percent of total billed charges,40% of total billed charges,37.19,340.8,
CA 15-3,7000169,CDM,302,RC,86300,HCPCS,Outpatient,,,118,94.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,15.61,75,,,fee schedule,75% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,40,,37.76,percent of total billed charges,40% of total billed charges,15.61,94.4,
PAP SMEAR,7039034,CDM,311,RC,88175,HCPCS,Outpatient,,,120,96.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,19.96,75,,,fee schedule,75% of CMS fee schedule,19.96,75,,,fee schedule,75% of CMS fee schedule,26.61,100,,,fee schedule,100% of CMS fee schedule,26.61,100,,,fee schedule,100% of CMS fee schedule,19.96,75,,,fee schedule,75% of CMS fee schedule,19.96,75,,,fee schedule,75% of CMS fee schedule,26.61,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,40,,38.4,percent of total billed charges,40% of total billed charges,19.96,96,
CHLAMYDIA TRACH AMP,7000284,CDM,306,RC,87491,HCPCS,Outpatient,,,71.8,57.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.44,80,,45.95,percent of total billed charges,80% of total billed charges,26.76,37.27,,21.41,percent of total billed charges,37.27% of total billed charges,26.76,37.27,,21.41,percent of total billed charges,37.27% of total billed charges,26.76,37.27,,21.41,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.72,40,,22.98,percent of total billed charges,40% of total billed charges,26.32,57.44,
GONORRHOEAE NEI AMP,7000284,CDM,306,RC,87591,HCPCS,Outpatient,,,123.48,98.78,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.78,80,,79.02,percent of total billed charges,80% of total billed charges,46.02,37.27,,36.82,percent of total billed charges,37.27% of total billed charges,46.02,37.27,,36.82,percent of total billed charges,37.27% of total billed charges,46.02,37.27,,36.82,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.39,40,,39.51,percent of total billed charges,40% of total billed charges,26.32,98.78,
BORDETELLA PERTU ANT,7000169,CDM,302,RC,86615,HCPCS,Outpatient,,,74,59.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,9.89,75,,,fee schedule,75% of CMS fee schedule,9.89,75,,,fee schedule,75% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,9.89,75,,,fee schedule,75% of CMS fee schedule,9.89,75,,,fee schedule,75% of CMS fee schedule,13.19,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,9.89,59.2,
HIV DNA PCR,7000284,CDM,306,RC,87535,HCPCS,Outpatient,,,113,90.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.2,40,,36.16,percent of total billed charges,40% of total billed charges,26.32,90.4,
PROTEIN OTHER SOURCE,7000029,CDM,301,RC,84157,HCPCS,Outpatient,,,22,17.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,3,75,,,fee schedule,75% of CMS fee schedule,3,75,,,fee schedule,75% of CMS fee schedule,4,100,,,fee schedule,100% of CMS fee schedule,4,100,,,fee schedule,100% of CMS fee schedule,3,75,,,fee schedule,75% of CMS fee schedule,3,75,,,fee schedule,75% of CMS fee schedule,4,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,3,17.6,
LYSOZYME,7000177,CDM,305,RC,85549,HCPCS,Outpatient,,,105,84.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,14.06,75,,,fee schedule,75% of CMS fee schedule,14.06,75,,,fee schedule,75% of CMS fee schedule,18.75,100,,,fee schedule,100% of CMS fee schedule,18.75,100,,,fee schedule,100% of CMS fee schedule,14.06,75,,,fee schedule,75% of CMS fee schedule,14.06,75,,,fee schedule,75% of CMS fee schedule,18.75,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,40,,33.6,percent of total billed charges,40% of total billed charges,14.06,84,
THALLIUM,7000029,CDM,301,RC,83018,HCPCS,Outpatient,,,169,135.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.2,80,,108.16,percent of total billed charges,80% of total billed charges,62.99,37.27,,50.39,percent of total billed charges,37.27% of total billed charges,62.99,37.27,,50.39,percent of total billed charges,37.27% of total billed charges,62.99,37.27,,50.39,percent of total billed charges,37.27% of total billed charges,16.47,75,,,fee schedule,75% of CMS fee schedule,16.47,75,,,fee schedule,75% of CMS fee schedule,21.96,100,,,fee schedule,100% of CMS fee schedule,21.96,100,,,fee schedule,100% of CMS fee schedule,16.47,75,,,fee schedule,75% of CMS fee schedule,16.47,75,,,fee schedule,75% of CMS fee schedule,21.96,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.6,40,,54.08,percent of total billed charges,40% of total billed charges,16.47,135.2,
CARNITINE,7000029,CDM,301,RC,82379,HCPCS,Outpatient,,,248,198.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.4,80,,158.72,percent of total billed charges,80% of total billed charges,92.43,37.27,,73.94,percent of total billed charges,37.27% of total billed charges,92.43,37.27,,73.94,percent of total billed charges,37.27% of total billed charges,92.43,37.27,,73.94,percent of total billed charges,37.27% of total billed charges,12.65,75,,,fee schedule,75% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.2,40,,79.36,percent of total billed charges,40% of total billed charges,12.65,198.4,
CANDIDA SPECIES DIRE,7000284,CDM,306,RC,87480,HCPCS,Outpatient,,,113,90.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,15.04,75,,,fee schedule,75% of CMS fee schedule,15.04,75,,,fee schedule,75% of CMS fee schedule,20.05,100,,,fee schedule,100% of CMS fee schedule,20.05,100,,,fee schedule,100% of CMS fee schedule,15.04,75,,,fee schedule,75% of CMS fee schedule,15.04,75,,,fee schedule,75% of CMS fee schedule,20.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.2,40,,36.16,percent of total billed charges,40% of total billed charges,15.04,90.4,
GARDNERELLA VAGINALI,7000284,CDM,306,RC,87510,HCPCS,Outpatient,,,113,90.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,15.04,75,,,fee schedule,75% of CMS fee schedule,15.04,75,,,fee schedule,75% of CMS fee schedule,20.05,100,,,fee schedule,100% of CMS fee schedule,20.05,100,,,fee schedule,100% of CMS fee schedule,15.04,75,,,fee schedule,75% of CMS fee schedule,15.04,75,,,fee schedule,75% of CMS fee schedule,20.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.2,40,,36.16,percent of total billed charges,40% of total billed charges,15.04,90.4,
TRICHOMONAS VAGINALI,7000284,CDM,306,RC,87660,HCPCS,Outpatient,,,113,90.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,15.04,75,,,fee schedule,75% of CMS fee schedule,15.04,75,,,fee schedule,75% of CMS fee schedule,20.05,100,,,fee schedule,100% of CMS fee schedule,20.05,100,,,fee schedule,100% of CMS fee schedule,15.04,75,,,fee schedule,75% of CMS fee schedule,15.04,75,,,fee schedule,75% of CMS fee schedule,20.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.2,40,,36.16,percent of total billed charges,40% of total billed charges,15.04,90.4,
TRICHOMONAS VAGINALI,7000284,CDM,306,RC,87798,HCPCS,Outpatient,,,197,157.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.8,40,,63.04,percent of total billed charges,40% of total billed charges,26.32,157.6,
HEPATITIS DELTA,7000169,CDM,302,RC,86692,HCPCS,Outpatient,,,122,97.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,12.87,75,,,fee schedule,75% of CMS fee schedule,12.87,75,,,fee schedule,75% of CMS fee schedule,17.16,100,,,fee schedule,100% of CMS fee schedule,17.16,100,,,fee schedule,100% of CMS fee schedule,12.87,75,,,fee schedule,75% of CMS fee schedule,12.87,75,,,fee schedule,75% of CMS fee schedule,17.16,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.8,40,,39.04,percent of total billed charges,40% of total billed charges,12.87,97.6,
HEP B CORE IGM ANTIB,7000169,CDM,302,RC,86705,HCPCS,Outpatient,,,66,52.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,8.83,75,,,fee schedule,75% of CMS fee schedule,8.83,75,,,fee schedule,75% of CMS fee schedule,11.77,100,,,fee schedule,100% of CMS fee schedule,11.77,100,,,fee schedule,100% of CMS fee schedule,8.83,75,,,fee schedule,75% of CMS fee schedule,8.83,75,,,fee schedule,75% of CMS fee schedule,11.77,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,8.83,52.8,
HEPATIS BE ANTIBODY,7000169,CDM,302,RC,86707,HCPCS,Outpatient,,,64,51.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,8.68,75,,,fee schedule,75% of CMS fee schedule,8.68,75,,,fee schedule,75% of CMS fee schedule,11.57,100,,,fee schedule,100% of CMS fee schedule,11.57,100,,,fee schedule,100% of CMS fee schedule,8.68,75,,,fee schedule,75% of CMS fee schedule,8.68,75,,,fee schedule,75% of CMS fee schedule,11.57,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,8.68,51.2,
PINWORM PREP,7000284,CDM,306,RC,87172,HCPCS,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,3.2,75,,,fee schedule,75% of CMS fee schedule,4.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,3.2,19.2,
FACTOR XI ACTIVITY,7000177,CDM,305,RC,85270,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,13.43,75,,,fee schedule,75% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,13.43,128,
FACTOR X ACTIVITY,7000177,CDM,305,RC,85260,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,13.43,75,,,fee schedule,75% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,13.43,128,
FACTOR V ACTIVITY,7000177,CDM,305,RC,85220,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,13.24,75,,,fee schedule,75% of CMS fee schedule,13.24,75,,,fee schedule,75% of CMS fee schedule,17.65,100,,,fee schedule,100% of CMS fee schedule,17.65,100,,,fee schedule,100% of CMS fee schedule,13.24,75,,,fee schedule,75% of CMS fee schedule,13.24,75,,,fee schedule,75% of CMS fee schedule,17.65,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,13.24,128,
TOXOPLASMA PCR,7000284,CDM,306,RC,87798,HCPCS,Outpatient,,,532,425.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,212.8,40,,170.24,percent of total billed charges,40% of total billed charges,26.32,425.6,
VOLUME MEAS URINE TI,7000029,CDM,301,RC,81050,HCPCS,Outpatient,,,8,6.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.73,75,,,fee schedule,75% of CMS fee schedule,2.73,75,,,fee schedule,75% of CMS fee schedule,3.64,100,,,fee schedule,100% of CMS fee schedule,3.64,100,,,fee schedule,100% of CMS fee schedule,2.73,75,,,fee schedule,75% of CMS fee schedule,2.73,75,,,fee schedule,75% of CMS fee schedule,3.64,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.73,6.4,
AEROBIC ISOLATE DEFI,7000284,CDM,306,RC,87077,HCPCS,Outpatient,,,46,36.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,6.06,75,,,fee schedule,75% of CMS fee schedule,6.06,75,,,fee schedule,75% of CMS fee schedule,8.08,100,,,fee schedule,100% of CMS fee schedule,8.08,100,,,fee schedule,100% of CMS fee schedule,6.06,75,,,fee schedule,75% of CMS fee schedule,6.06,75,,,fee schedule,75% of CMS fee schedule,8.08,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,6.06,36.8,
LBC COLD SCREEN,7000169,CDM,302,RC,86940,HCPCS,Outpatient,,,53,42.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,6.58,75,,,fee schedule,75% of CMS fee schedule,6.58,75,,,fee schedule,75% of CMS fee schedule,8.77,100,,,fee schedule,100% of CMS fee schedule,8.77,100,,,fee schedule,100% of CMS fee schedule,6.58,75,,,fee schedule,75% of CMS fee schedule,6.58,75,,,fee schedule,75% of CMS fee schedule,8.77,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,6.58,42.4,
HIV 2 WESTERN BLOT,7000169,CDM,302,RC,86689,HCPCS,Outpatient,,,269,215.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,215.2,80,,172.16,percent of total billed charges,80% of total billed charges,100.26,37.27,,80.21,percent of total billed charges,37.27% of total billed charges,100.26,37.27,,80.21,percent of total billed charges,37.27% of total billed charges,100.26,37.27,,80.21,percent of total billed charges,37.27% of total billed charges,14.51,75,,,fee schedule,75% of CMS fee schedule,14.51,75,,,fee schedule,75% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,14.51,75,,,fee schedule,75% of CMS fee schedule,14.51,75,,,fee schedule,75% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.6,40,,86.08,percent of total billed charges,40% of total billed charges,14.51,215.2,
RUBELLA IGM,7000169,CDM,302,RC,86762,HCPCS,Outpatient,,,196,156.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,10.79,75,,,fee schedule,75% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.4,40,,62.72,percent of total billed charges,40% of total billed charges,10.79,156.8,
CHROMOGRANIN A,7000169,CDM,302,RC,86316,HCPCS,Outpatient,,,283,226.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% of total billed charges,15.61,75,,,fee schedule,75% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.2,40,,90.56,percent of total billed charges,40% of total billed charges,15.61,226.4,
BLD GLUCOSE/ACCUCHEK,7012032,CDM,300,RC,82962,HCPCS,Outpatient,,,10,8.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,2.46,8,
VENIPUNCTURE ER,7012032,CDM,300,RC,36415,HCPCS,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,6.62,22.4,
ACCUCHEK,7012032,CDM,300,RC,82962,HCPCS,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,2.46,16,
ACCUCHEK,7012032,CDM,300,RC,82962,HCPCS,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,2.46,16,
VENIPUNCTURE,7012032,CDM,300,RC,36415,HCPCS,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,6.62,16,
HEPATITIS B QUAN PCR,7000284,CDM,306,RC,87517,HCPCS,Outpatient,,,491,392.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,392.8,80,,314.24,percent of total billed charges,80% of total billed charges,183,37.27,,146.4,percent of total billed charges,37.27% of total billed charges,183,37.27,,146.4,percent of total billed charges,37.27% of total billed charges,183,37.27,,146.4,percent of total billed charges,37.27% of total billed charges,32.13,75,,,fee schedule,75% of CMS fee schedule,32.13,75,,,fee schedule,75% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,32.13,75,,,fee schedule,75% of CMS fee schedule,32.13,75,,,fee schedule,75% of CMS fee schedule,42.84,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.4,40,,157.12,percent of total billed charges,40% of total billed charges,32.13,392.8,
BIOTINIDASE,7000029,CDM,301,RC,82261,HCPCS,Outpatient,,,132,105.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.6,80,,84.48,percent of total billed charges,80% of total billed charges,49.2,37.27,,39.36,percent of total billed charges,37.27% of total billed charges,49.2,37.27,,39.36,percent of total billed charges,37.27% of total billed charges,49.2,37.27,,39.36,percent of total billed charges,37.27% of total billed charges,12.65,75,,,fee schedule,75% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,40,,42.24,percent of total billed charges,40% of total billed charges,12.65,105.6,
SCABIES EXAM,7000284,CDM,306,RC,87169,HCPCS,Outpatient,,,69,55.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,3.23,75,,,fee schedule,75% of CMS fee schedule,3.23,75,,,fee schedule,75% of CMS fee schedule,4.31,100,,,fee schedule,100% of CMS fee schedule,4.31,100,,,fee schedule,100% of CMS fee schedule,3.23,75,,,fee schedule,75% of CMS fee schedule,3.23,75,,,fee schedule,75% of CMS fee schedule,4.31,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.6,40,,22.08,percent of total billed charges,40% of total billed charges,3.23,55.2,
T3 REVERSE,7000029,CDM,301,RC,84482,HCPCS,Outpatient,,,53,42.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,11.82,75,,,fee schedule,75% of CMS fee schedule,11.82,75,,,fee schedule,75% of CMS fee schedule,15.76,100,,,fee schedule,100% of CMS fee schedule,15.76,100,,,fee schedule,100% of CMS fee schedule,11.82,75,,,fee schedule,75% of CMS fee schedule,11.82,75,,,fee schedule,75% of CMS fee schedule,15.76,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,11.82,42.4,
FACTOR II ACTIVITY,7000177,CDM,305,RC,85210,HCPCS,Outpatient,,,101,80.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,9.74,75,,,fee schedule,75% of CMS fee schedule,9.74,75,,,fee schedule,75% of CMS fee schedule,12.98,100,,,fee schedule,100% of CMS fee schedule,12.98,100,,,fee schedule,100% of CMS fee schedule,9.74,75,,,fee schedule,75% of CMS fee schedule,9.74,75,,,fee schedule,75% of CMS fee schedule,12.98,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.4,40,,32.32,percent of total billed charges,40% of total billed charges,9.74,80.8,
ANTI-HISTONE ANTIBOD,7000169,CDM,302,RC,86235,HCPCS,Outpatient,,,64,51.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,13.45,51.2,
ANTI-EXT NUC AG1,7000169,CDM,302,RC,86235,HCPCS,Outpatient,,,64,51.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,13.45,51.2,
ANTI-EXT NUC AG2,7000169,CDM,302,RC,86235,HCPCS,Outpatient,,,64,51.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,13.45,51.2,
HIGH RESOLUTION STDY,7039034,CDM,311,RC,88289,HCPCS,Outpatient,,,218,174.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% of total billed charges,25.82,75,,,fee schedule,75% of CMS fee schedule,25.82,75,,,fee schedule,75% of CMS fee schedule,34.43,100,,,fee schedule,100% of CMS fee schedule,34.43,100,,,fee schedule,100% of CMS fee schedule,25.82,75,,,fee schedule,75% of CMS fee schedule,25.82,75,,,fee schedule,75% of CMS fee schedule,34.43,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.2,40,,69.76,percent of total billed charges,40% of total billed charges,25.82,174.4,
FRAGILE X GENE ANALY,7000029,CDM,301,RC,81243,HCPCS,Outpatient,,,410,328.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328,80,,262.4,percent of total billed charges,80% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,42.78,75,,,fee schedule,75% of CMS fee schedule,42.78,75,,,fee schedule,75% of CMS fee schedule,57.04,100,,,fee schedule,100% of CMS fee schedule,57.04,100,,,fee schedule,100% of CMS fee schedule,42.78,75,,,fee schedule,75% of CMS fee schedule,42.78,75,,,fee schedule,75% of CMS fee schedule,57.04,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164,40,,131.2,percent of total billed charges,40% of total billed charges,42.78,328,
BLD GLUCOSE/ACCUCHEK,7012032,CDM,300,RC,82962,HCPCS,Outpatient,,,10,8.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,2.46,8,
ECHINOCOCCUA AB,7000169,CDM,302,RC,86682,HCPCS,Outpatient,,,71,56.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,9.76,75,,,fee schedule,75% of CMS fee schedule,9.76,75,,,fee schedule,75% of CMS fee schedule,13.01,100,,,fee schedule,100% of CMS fee schedule,13.01,100,,,fee schedule,100% of CMS fee schedule,9.76,75,,,fee schedule,75% of CMS fee schedule,9.76,75,,,fee schedule,75% of CMS fee schedule,13.01,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.4,40,,22.72,percent of total billed charges,40% of total billed charges,9.76,56.8,
AMINO ACID 6+ QUANT,7000029,CDM,301,RC,82139,HCPCS,Outpatient,,,333,266.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,266.4,80,,213.12,percent of total billed charges,80% of total billed charges,124.11,37.27,,99.29,percent of total billed charges,37.27% of total billed charges,124.11,37.27,,99.29,percent of total billed charges,37.27% of total billed charges,124.11,37.27,,99.29,percent of total billed charges,37.27% of total billed charges,12.65,75,,,fee schedule,75% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.2,40,,106.56,percent of total billed charges,40% of total billed charges,12.65,266.4,
HEMOPHIL INFLU B1GG,7000169,CDM,302,RC,86684,HCPCS,Outpatient,,,87,69.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,11.88,75,,,fee schedule,75% of CMS fee schedule,11.88,75,,,fee schedule,75% of CMS fee schedule,15.84,100,,,fee schedule,100% of CMS fee schedule,15.84,100,,,fee schedule,100% of CMS fee schedule,11.88,75,,,fee schedule,75% of CMS fee schedule,11.88,75,,,fee schedule,75% of CMS fee schedule,15.84,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,40,,27.84,percent of total billed charges,40% of total billed charges,11.88,69.6,
HYDROXCORTICOSTER 17,7012032,CDM,300,RC,83491,HCPCS,Outpatient,,,95,76.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,13.43,75,,,fee schedule,75% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,13.43,75,,,fee schedule,75% of CMS fee schedule,17.9,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38,40,,30.4,percent of total billed charges,40% of total billed charges,13.43,76,
LIPOPRO W/PHOS A2,7000029,CDM,301,RC,83698,HCPCS,Outpatient,,,186,148.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,34.73,75,,,fee schedule,75% of CMS fee schedule,34.73,75,,,fee schedule,75% of CMS fee schedule,46.31,100,,,fee schedule,100% of CMS fee schedule,46.31,100,,,fee schedule,100% of CMS fee schedule,34.73,75,,,fee schedule,75% of CMS fee schedule,34.73,75,,,fee schedule,75% of CMS fee schedule,46.31,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,40,,59.52,percent of total billed charges,40% of total billed charges,34.73,148.8,
MICRO CONCENTRATION,7000284,CDM,306,RC,87015,HCPCS,Outpatient,,,38,30.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,5.01,75,,,fee schedule,75% of CMS fee schedule,5.01,75,,,fee schedule,75% of CMS fee schedule,6.68,100,,,fee schedule,100% of CMS fee schedule,6.68,100,,,fee schedule,100% of CMS fee schedule,5.01,75,,,fee schedule,75% of CMS fee schedule,5.01,75,,,fee schedule,75% of CMS fee schedule,6.68,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,5.01,30.4,
PLATELET FUNCT ASSAY,7000177,CDM,305,RC,85576,HCPCS,Outpatient,,,181,144.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.8,80,,115.84,percent of total billed charges,80% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,67.46,37.27,,53.97,percent of total billed charges,37.27% of total billed charges,18.68,75,,,fee schedule,75% of CMS fee schedule,18.68,75,,,fee schedule,75% of CMS fee schedule,24.91,100,,,fee schedule,100% of CMS fee schedule,24.91,100,,,fee schedule,100% of CMS fee schedule,18.68,75,,,fee schedule,75% of CMS fee schedule,18.68,75,,,fee schedule,75% of CMS fee schedule,24.91,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.4,40,,57.92,percent of total billed charges,40% of total billed charges,18.68,144.8,
QUANTIFERON TB GOLD,7000169,CDM,302,RC,86480,HCPCS,Outpatient,,,340,272.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272,80,,217.6,percent of total billed charges,80% of total billed charges,126.72,37.27,,101.38,percent of total billed charges,37.27% of total billed charges,126.72,37.27,,101.38,percent of total billed charges,37.27% of total billed charges,126.72,37.27,,101.38,percent of total billed charges,37.27% of total billed charges,46.49,75,,,fee schedule,75% of CMS fee schedule,46.49,75,,,fee schedule,75% of CMS fee schedule,61.98,100,,,fee schedule,100% of CMS fee schedule,61.98,100,,,fee schedule,100% of CMS fee schedule,46.49,75,,,fee schedule,75% of CMS fee schedule,46.49,75,,,fee schedule,75% of CMS fee schedule,61.98,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136,40,,108.8,percent of total billed charges,40% of total billed charges,46.49,272,
TRICHLORO ACID BLD,7000029,CDM,301,RC,84600,HCPCS,Outpatient,,,214,171.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,79.76,37.27,,63.81,percent of total billed charges,37.27% of total billed charges,79.76,37.27,,63.81,percent of total billed charges,37.27% of total billed charges,79.76,37.27,,63.81,percent of total billed charges,37.27% of total billed charges,12.83,75,,,fee schedule,75% of CMS fee schedule,12.83,75,,,fee schedule,75% of CMS fee schedule,17.11,100,,,fee schedule,100% of CMS fee schedule,17.11,100,,,fee schedule,100% of CMS fee schedule,12.83,75,,,fee schedule,75% of CMS fee schedule,12.83,75,,,fee schedule,75% of CMS fee schedule,17.11,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.6,40,,68.48,percent of total billed charges,40% of total billed charges,12.83,171.2,
HIV1 RNA PCR VIRAL,7000284,CDM,306,RC,87536,HCPCS,Outpatient,,,405,324.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,324,80,,259.2,percent of total billed charges,80% of total billed charges,150.94,37.27,,120.75,percent of total billed charges,37.27% of total billed charges,150.94,37.27,,120.75,percent of total billed charges,37.27% of total billed charges,150.94,37.27,,120.75,percent of total billed charges,37.27% of total billed charges,63.83,75,,,fee schedule,75% of CMS fee schedule,63.83,75,,,fee schedule,75% of CMS fee schedule,85.1,100,,,fee schedule,100% of CMS fee schedule,85.1,100,,,fee schedule,100% of CMS fee schedule,63.83,75,,,fee schedule,75% of CMS fee schedule,63.83,75,,,fee schedule,75% of CMS fee schedule,85.1,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162,40,,129.6,percent of total billed charges,40% of total billed charges,63.83,324,
C04 HELPER/INDUCER,7000029,CDM,301,RC,86361,HCPCS,Outpatient,,,105,84.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,20.09,75,,,fee schedule,75% of CMS fee schedule,20.09,75,,,fee schedule,75% of CMS fee schedule,26.78,100,,,fee schedule,100% of CMS fee schedule,26.78,100,,,fee schedule,100% of CMS fee schedule,20.09,75,,,fee schedule,75% of CMS fee schedule,20.09,75,,,fee schedule,75% of CMS fee schedule,26.78,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,40,,33.6,percent of total billed charges,40% of total billed charges,20.09,84,
HEP B CORE AB IGM,7000169,CDM,302,RC,86705,HCPCS,Outpatient,,,64,51.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,8.83,75,,,fee schedule,75% of CMS fee schedule,8.83,75,,,fee schedule,75% of CMS fee schedule,11.77,100,,,fee schedule,100% of CMS fee schedule,11.77,100,,,fee schedule,100% of CMS fee schedule,8.83,75,,,fee schedule,75% of CMS fee schedule,8.83,75,,,fee schedule,75% of CMS fee schedule,11.77,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,8.83,51.2,
TESTOSTERONE/WOMEN/C,7000029,CDM,301,RC,84403,HCPCS,Outpatient,,,406,324.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,324.8,80,,259.84,percent of total billed charges,80% of total billed charges,151.32,37.27,,121.06,percent of total billed charges,37.27% of total billed charges,151.32,37.27,,121.06,percent of total billed charges,37.27% of total billed charges,151.32,37.27,,121.06,percent of total billed charges,37.27% of total billed charges,19.36,75,,,fee schedule,75% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.4,40,,129.92,percent of total billed charges,40% of total billed charges,19.36,324.8,
CRYSTAL SYNOVIAL FLU,7000177,CDM,305,RC,89060,HCPCS,Outpatient,,,183,146.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% of total billed charges,5.5,75,,,fee schedule,75% of CMS fee schedule,5.5,75,,,fee schedule,75% of CMS fee schedule,7.33,100,,,fee schedule,100% of CMS fee schedule,7.33,100,,,fee schedule,100% of CMS fee schedule,5.5,75,,,fee schedule,75% of CMS fee schedule,5.5,75,,,fee schedule,75% of CMS fee schedule,7.33,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,40,,58.56,percent of total billed charges,40% of total billed charges,5.5,146.4,
BLD GLUCOSE/ACCUCHEK,7012032,CDM,300,RC,82962,HCPCS,Outpatient,,,10,8.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,2.46,8,
BLD GLUCOSE/ACCUCHEK,7012032,CDM,300,RC,82962,HCPCS,Outpatient,,,10,8.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,2.46,8,
ACCUCHEK (BLD GLUC),7012032,CDM,300,RC,82962,HCPCS,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,40,,3.2,percent of total billed charges,40% of total billed charges,2.46,8,
CLOSTRIDIUM DIFFICIL,7000284,CDM,306,RC,87493,HCPCS,Outpatient,,,186,148.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,27.95,75,,,fee schedule,75% of CMS fee schedule,27.95,75,,,fee schedule,75% of CMS fee schedule,37.27,100,,,fee schedule,100% of CMS fee schedule,37.27,100,,,fee schedule,100% of CMS fee schedule,27.95,75,,,fee schedule,75% of CMS fee schedule,27.95,75,,,fee schedule,75% of CMS fee schedule,37.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,40,,59.52,percent of total billed charges,40% of total billed charges,27.95,148.8,
17-HYDROXYPREGNEOLON,7000029,CDM,301,RC,84143,HCPCS,Outpatient,,,150,120.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,17.11,75,,,fee schedule,75% of CMS fee schedule,17.11,75,,,fee schedule,75% of CMS fee schedule,22.81,100,,,fee schedule,100% of CMS fee schedule,22.81,100,,,fee schedule,100% of CMS fee schedule,17.11,75,,,fee schedule,75% of CMS fee schedule,17.11,75,,,fee schedule,75% of CMS fee schedule,22.81,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,40,,48,percent of total billed charges,40% of total billed charges,17.11,120,
THYROID HORMONE T3T4,7000029,CDM,301,RC,84479,HCPCS,Outpatient,,,25,20.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,4.85,75,,,fee schedule,75% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,4.85,20,
"DEOXYCORTISOL, 11",7000029,CDM,301,RC,82634,HCPCS,Outpatient,,,111,88.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% of total billed charges,21.96,75,,,fee schedule,75% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.4,40,,35.52,percent of total billed charges,40% of total billed charges,21.96,88.8,
VISCOSITY,7000169,CDM,302,RC,85810,HCPCS,Outpatient,,,63,50.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,8.75,75,,,fee schedule,75% of CMS fee schedule,8.75,75,,,fee schedule,75% of CMS fee schedule,11.67,100,,,fee schedule,100% of CMS fee schedule,11.67,100,,,fee schedule,100% of CMS fee schedule,8.75,75,,,fee schedule,75% of CMS fee schedule,8.75,75,,,fee schedule,75% of CMS fee schedule,11.67,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,40,,20.16,percent of total billed charges,40% of total billed charges,8.75,50.4,
HERPES SIMPLEX VIRUS,7000284,CDM,306,RC,87529,HCPCS,Outpatient,,,186,148.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,40,,59.52,percent of total billed charges,40% of total billed charges,26.32,148.8,
MYCOBACTERIUM TUBERC,7000284,CDM,306,RC,87556,HCPCS,Outpatient,,,186,148.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,31.26,75,,,fee schedule,75% of CMS fee schedule,31.26,75,,,fee schedule,75% of CMS fee schedule,41.68,100,,,fee schedule,100% of CMS fee schedule,41.68,100,,,fee schedule,100% of CMS fee schedule,31.26,75,,,fee schedule,75% of CMS fee schedule,31.26,75,,,fee schedule,75% of CMS fee schedule,41.68,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,40,,59.52,percent of total billed charges,40% of total billed charges,31.26,148.8,
HISTOPLASMA,7000169,CDM,302,RC,86698,HCPCS,Outpatient,,,66,52.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,10.34,75,,,fee schedule,75% of CMS fee schedule,10.34,75,,,fee schedule,75% of CMS fee schedule,13.79,100,,,fee schedule,100% of CMS fee schedule,13.79,100,,,fee schedule,100% of CMS fee schedule,10.34,75,,,fee schedule,75% of CMS fee schedule,10.34,75,,,fee schedule,75% of CMS fee schedule,13.79,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,10.34,52.8,
"STOOL,AEROBIC ADD PA",7000284,CDM,306,RC,87046,HCPCS,Outpatient,,,109,87.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,7.08,75,,,fee schedule,75% of CMS fee schedule,7.08,75,,,fee schedule,75% of CMS fee schedule,9.44,100,,,fee schedule,100% of CMS fee schedule,9.44,100,,,fee schedule,100% of CMS fee schedule,7.08,75,,,fee schedule,75% of CMS fee schedule,7.08,75,,,fee schedule,75% of CMS fee schedule,9.44,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.6,40,,34.88,percent of total billed charges,40% of total billed charges,7.08,87.2,
ETHOSUXIMIDE,7000029,CDM,301,RC,80168,HCPCS,Outpatient,,,87,69.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,12.26,75,,,fee schedule,75% of CMS fee schedule,12.26,75,,,fee schedule,75% of CMS fee schedule,16.34,100,,,fee schedule,100% of CMS fee schedule,16.34,100,,,fee schedule,100% of CMS fee schedule,12.26,75,,,fee schedule,75% of CMS fee schedule,12.26,75,,,fee schedule,75% of CMS fee schedule,16.34,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,40,,27.84,percent of total billed charges,40% of total billed charges,12.26,69.6,
EHRLICHIA,7000169,CDM,302,RC,86666,HCPCS,Outpatient,,,155,124.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,7.64,75,,,fee schedule,75% of CMS fee schedule,7.64,75,,,fee schedule,75% of CMS fee schedule,10.18,100,,,fee schedule,100% of CMS fee schedule,10.18,100,,,fee schedule,100% of CMS fee schedule,7.64,75,,,fee schedule,75% of CMS fee schedule,7.64,75,,,fee schedule,75% of CMS fee schedule,10.18,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62,40,,49.6,percent of total billed charges,40% of total billed charges,7.64,124,
MICRODILUTION OR AGA,7000284,CDM,306,RC,87186,HCPCS,Outpatient,,,48,38.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,6.49,75,,,fee schedule,75% of CMS fee schedule,6.49,75,,,fee schedule,75% of CMS fee schedule,8.65,100,,,fee schedule,100% of CMS fee schedule,8.65,100,,,fee schedule,100% of CMS fee schedule,6.49,75,,,fee schedule,75% of CMS fee schedule,6.49,75,,,fee schedule,75% of CMS fee schedule,8.65,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,40,,15.36,percent of total billed charges,40% of total billed charges,6.49,38.4,
"CULTURE,FUNGI,DEFINI",7000284,CDM,306,RC,87106,HCPCS,Outpatient,,,56,44.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,7.74,75,,,fee schedule,75% of CMS fee schedule,7.74,75,,,fee schedule,75% of CMS fee schedule,10.32,100,,,fee schedule,100% of CMS fee schedule,10.32,100,,,fee schedule,100% of CMS fee schedule,7.74,75,,,fee schedule,75% of CMS fee schedule,7.74,75,,,fee schedule,75% of CMS fee schedule,10.32,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,40,,17.92,percent of total billed charges,40% of total billed charges,7.74,44.8,
BETA 2 GLYCOPRO ANTI,7000169,CDM,302,RC,86146,HCPCS,Outpatient,,,64,51.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,19.09,75,,,fee schedule,75% of CMS fee schedule,19.09,75,,,fee schedule,75% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,19.09,75,,,fee schedule,75% of CMS fee schedule,19.09,75,,,fee schedule,75% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,19.09,51.2,
WEST NILE VIR AB IGM,7000169,CDM,302,RC,86788,HCPCS,Outpatient,,,90,72.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,12.64,75,,,fee schedule,75% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,12.64,75,,,fee schedule,75% of CMS fee schedule,16.85,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,40,,28.8,percent of total billed charges,40% of total billed charges,12.64,72,
AB BLASTOMYCES,7000169,CDM,302,RC,86612,HCPCS,Outpatient,,,69,55.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,9.68,75,,,fee schedule,75% of CMS fee schedule,9.68,75,,,fee schedule,75% of CMS fee schedule,12.9,100,,,fee schedule,100% of CMS fee schedule,12.9,100,,,fee schedule,100% of CMS fee schedule,9.68,75,,,fee schedule,75% of CMS fee schedule,9.68,75,,,fee schedule,75% of CMS fee schedule,12.9,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.6,40,,22.08,percent of total billed charges,40% of total billed charges,9.68,55.2,
METANEPHRINES,7000029,CDM,301,RC,83835,HCPCS,Outpatient,,,90,72.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,12.71,75,,,fee schedule,75% of CMS fee schedule,12.71,75,,,fee schedule,75% of CMS fee schedule,16.94,100,,,fee schedule,100% of CMS fee schedule,16.94,100,,,fee schedule,100% of CMS fee schedule,12.71,75,,,fee schedule,75% of CMS fee schedule,12.71,75,,,fee schedule,75% of CMS fee schedule,16.94,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,40,,28.8,percent of total billed charges,40% of total billed charges,12.71,72,
ISLET CELL ANITBODY,7000029,CDM,301,RC,86341,HCPCS,Outpatient,,,105,84.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,17.68,75,,,fee schedule,75% of CMS fee schedule,17.68,75,,,fee schedule,75% of CMS fee schedule,23.57,100,,,fee schedule,100% of CMS fee schedule,23.57,100,,,fee schedule,100% of CMS fee schedule,17.68,75,,,fee schedule,75% of CMS fee schedule,17.68,75,,,fee schedule,75% of CMS fee schedule,23.57,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,40,,33.6,percent of total billed charges,40% of total billed charges,17.68,84,
ANTI-AMOEBA SEROLOGY,7000029,CDM,301,RC,86753,HCPCS,Outpatient,,,66,52.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,9.29,75,,,fee schedule,75% of CMS fee schedule,9.29,75,,,fee schedule,75% of CMS fee schedule,12.39,100,,,fee schedule,100% of CMS fee schedule,12.39,100,,,fee schedule,100% of CMS fee schedule,9.29,75,,,fee schedule,75% of CMS fee schedule,9.29,75,,,fee schedule,75% of CMS fee schedule,12.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,9.29,52.8,
BORDATELLA PERTUSSIS,7000284,CDM,306,RC,87798,HCPCS,Outpatient,,,186,148.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,40,,59.52,percent of total billed charges,40% of total billed charges,26.32,148.8,
CYSTIC FIBR DNA PROF,7000029,CDM,301,RC,81220,HCPCS,Outpatient,,,1113.2,890.56,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,890.56,80,,712.45,percent of total billed charges,80% of total billed charges,414.89,37.27,,331.91,percent of total billed charges,37.27% of total billed charges,414.89,37.27,,331.91,percent of total billed charges,37.27% of total billed charges,414.89,37.27,,331.91,percent of total billed charges,37.27% of total billed charges,417.45,75,,,fee schedule,75% of CMS fee schedule,417.45,75,,,fee schedule,75% of CMS fee schedule,556.6,100,,,fee schedule,100% of CMS fee schedule,556.6,100,,,fee schedule,100% of CMS fee schedule,417.45,75,,,fee schedule,75% of CMS fee schedule,417.45,75,,,fee schedule,75% of CMS fee schedule,556.6,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,445.28,40,,356.22,percent of total billed charges,40% of total billed charges,414.89,890.56,
ORGANISM ID-AEROBIC,7000284,CDM,306,RC,87077,HCPCS,Outpatient,,,43,34.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,6.06,75,,,fee schedule,75% of CMS fee schedule,6.06,75,,,fee schedule,75% of CMS fee schedule,8.08,100,,,fee schedule,100% of CMS fee schedule,8.08,100,,,fee schedule,100% of CMS fee schedule,6.06,75,,,fee schedule,75% of CMS fee schedule,6.06,75,,,fee schedule,75% of CMS fee schedule,8.08,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.2,40,,13.76,percent of total billed charges,40% of total billed charges,6.06,34.4,
IL28-B COLLECTION FE,7012032,CDM,300,RC,36415,HCPCS,Outpatient,,,25,20.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,6.62,20,
IGF3,7000029,CDM,301,RC,83520,HCPCS,Outpatient,,,57,45.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,12.95,75,,,fee schedule,75% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,40,,18.24,percent of total billed charges,40% of total billed charges,12.95,45.6,
DISOPHRAMIDE LEVEL,7000029,CDM,301,RC,80299,HCPCS,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,13.98,58.4,
BLASTOMYCES ANTIBODI,7000029,CDM,301,RC,86612,HCPCS,Outpatient,,,69,55.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,9.68,75,,,fee schedule,75% of CMS fee schedule,9.68,75,,,fee schedule,75% of CMS fee schedule,12.9,100,,,fee schedule,100% of CMS fee schedule,12.9,100,,,fee schedule,100% of CMS fee schedule,9.68,75,,,fee schedule,75% of CMS fee schedule,9.68,75,,,fee schedule,75% of CMS fee schedule,12.9,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.6,40,,22.08,percent of total billed charges,40% of total billed charges,9.68,55.2,
SERUM BILE ACID,7000029,CDM,301,RC,82239,HCPCS,Outpatient,,,91,72.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,12.84,75,,,fee schedule,75% of CMS fee schedule,12.84,75,,,fee schedule,75% of CMS fee schedule,17.12,100,,,fee schedule,100% of CMS fee schedule,17.12,100,,,fee schedule,100% of CMS fee schedule,12.84,75,,,fee schedule,75% of CMS fee schedule,12.84,75,,,fee schedule,75% of CMS fee schedule,17.12,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.4,40,,29.12,percent of total billed charges,40% of total billed charges,12.84,72.8,
MISC COLL PROC FEE,7012032,CDM,300,RC,36415,HCPCS,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,6.62,20,
NUSWAB FOR HSV 1 & 2,7000284,CDM,306,RC,87529,HCPCS,Outpatient,,,445,356.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,356,80,,284.8,percent of total billed charges,80% of total billed charges,165.85,37.27,,132.68,percent of total billed charges,37.27% of total billed charges,165.85,37.27,,132.68,percent of total billed charges,37.27% of total billed charges,165.85,37.27,,132.68,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,178,40,,142.4,percent of total billed charges,40% of total billed charges,26.32,356,
DRUG SCREEN URINE 9,7000029,CDM,301,RC,80307,HCPCS,Outpatient,,,278,222.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.4,80,,177.92,percent of total billed charges,80% of total billed charges,103.61,37.27,,82.89,percent of total billed charges,37.27% of total billed charges,103.61,37.27,,82.89,percent of total billed charges,37.27% of total billed charges,103.61,37.27,,82.89,percent of total billed charges,37.27% of total billed charges,46.61,75,,,fee schedule,75% of CMS fee schedule,46.61,75,,,fee schedule,75% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,46.61,75,,,fee schedule,75% of CMS fee schedule,46.61,75,,,fee schedule,75% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.2,40,,88.96,percent of total billed charges,40% of total billed charges,46.61,222.4,
PSA TOTAL DX,7000029,CDM,301,RC,84153,HCPCS,Outpatient,,,155,124.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,13.79,75,,,fee schedule,75% of CMS fee schedule,13.79,75,,,fee schedule,75% of CMS fee schedule,18.39,100,,,fee schedule,100% of CMS fee schedule,18.39,100,,,fee schedule,100% of CMS fee schedule,13.79,75,,,fee schedule,75% of CMS fee schedule,13.79,75,,,fee schedule,75% of CMS fee schedule,18.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62,40,,49.6,percent of total billed charges,40% of total billed charges,13.79,124,
TRICH VAG BY NAA,7000284,CDM,306,RC,87661,HCPCS,Outpatient,,,120,96.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,40,,38.4,percent of total billed charges,40% of total billed charges,26.32,96,
C ALBICANS C GLABRAT,7000284,CDM,306,RC,87481,HCPCS,Outpatient,,,183,146.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.2,40,,58.56,percent of total billed charges,40% of total billed charges,26.32,146.4,
ASSAY URINE SULFATE,7012032,CDM,300,RC,84392,HCPCS,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,4.12,75,,,fee schedule,75% of CMS fee schedule,4.12,75,,,fee schedule,75% of CMS fee schedule,5.49,100,,,fee schedule,100% of CMS fee schedule,5.49,100,,,fee schedule,100% of CMS fee schedule,4.12,75,,,fee schedule,75% of CMS fee schedule,4.12,75,,,fee schedule,75% of CMS fee schedule,5.49,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,4.12,20,
PHOSPHOLIPID ANTIBOD,7000169,CDM,302,RC,86148,HCPCS,Outpatient,,,62,49.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,12.05,75,,,fee schedule,75% of CMS fee schedule,12.05,75,,,fee schedule,75% of CMS fee schedule,16.07,100,,,fee schedule,100% of CMS fee schedule,16.07,100,,,fee schedule,100% of CMS fee schedule,12.05,75,,,fee schedule,75% of CMS fee schedule,12.05,75,,,fee schedule,75% of CMS fee schedule,16.07,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,40,,19.84,percent of total billed charges,40% of total billed charges,12.05,49.6,
THROM TIME PAR SUBS,7000177,CDM,305,RC,85732,HCPCS,Outpatient,,,34,27.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,4.85,75,,,fee schedule,75% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,4.85,27.2,
THROMBOPLASTIN INHIB,7000177,CDM,305,RC,85705,HCPCS,Outpatient,,,38,30.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,7.22,75,,,fee schedule,75% of CMS fee schedule,7.22,75,,,fee schedule,75% of CMS fee schedule,9.63,100,,,fee schedule,100% of CMS fee schedule,9.63,100,,,fee schedule,100% of CMS fee schedule,7.22,75,,,fee schedule,75% of CMS fee schedule,7.22,75,,,fee schedule,75% of CMS fee schedule,9.63,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,7.22,30.4,
CI ESTERASE INHIB SE,7000169,CDM,302,RC,86160,HCPCS,Outpatient,,,64,51.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,9,75,,,fee schedule,75% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,9,75,,,fee schedule,75% of CMS fee schedule,12,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,9,51.2,
LYMES WESTERN BLOT,7000169,CDM,302,RC,86617,HCPCS,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,11.62,75,,,fee schedule,75% of CMS fee schedule,11.62,75,,,fee schedule,75% of CMS fee schedule,15.49,100,,,fee schedule,100% of CMS fee schedule,15.49,100,,,fee schedule,100% of CMS fee schedule,11.62,75,,,fee schedule,75% of CMS fee schedule,11.62,75,,,fee schedule,75% of CMS fee schedule,15.49,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,11.62,58.4,
THROMBIN TIME,7000177,CDM,305,RC,85670,HCPCS,Outpatient,,,67,53.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,4.33,75,,,fee schedule,75% of CMS fee schedule,4.33,75,,,fee schedule,75% of CMS fee schedule,5.77,100,,,fee schedule,100% of CMS fee schedule,5.77,100,,,fee schedule,100% of CMS fee schedule,4.33,75,,,fee schedule,75% of CMS fee schedule,4.33,75,,,fee schedule,75% of CMS fee schedule,5.77,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,4.33,53.6,
BUN BODY FLUID,7000029,CDM,301,RC,84520,HCPCS,Outpatient,,,21,16.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,2.96,75,,,fee schedule,75% of CMS fee schedule,2.96,75,,,fee schedule,75% of CMS fee schedule,3.95,100,,,fee schedule,100% of CMS fee schedule,3.95,100,,,fee schedule,100% of CMS fee schedule,2.96,75,,,fee schedule,75% of CMS fee schedule,2.96,75,,,fee schedule,75% of CMS fee schedule,3.95,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,2.96,16.8,
KETONES URINE QUAL,7000029,CDM,301,RC,82009,HCPCS,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,3.39,75,,,fee schedule,75% of CMS fee schedule,3.39,75,,,fee schedule,75% of CMS fee schedule,4.52,100,,,fee schedule,100% of CMS fee schedule,4.52,100,,,fee schedule,100% of CMS fee schedule,3.39,75,,,fee schedule,75% of CMS fee schedule,3.39,75,,,fee schedule,75% of CMS fee schedule,4.52,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,3.39,19.2,
B CELLS TOTAL COUNT,7000169,CDM,302,RC,86355,HCPCS,Outpatient,,,200,160.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160,80,,128,percent of total billed charges,80% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,28.3,75,,,fee schedule,75% of CMS fee schedule,28.3,75,,,fee schedule,75% of CMS fee schedule,37.73,100,,,fee schedule,100% of CMS fee schedule,37.73,100,,,fee schedule,100% of CMS fee schedule,28.3,75,,,fee schedule,75% of CMS fee schedule,28.3,75,,,fee schedule,75% of CMS fee schedule,37.73,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,40,,64,percent of total billed charges,40% of total billed charges,28.3,160,
T CELL ABS COUNT/RAT,7000169,CDM,302,RC,86360,HCPCS,Outpatient,,,214,171.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,79.76,37.27,,63.81,percent of total billed charges,37.27% of total billed charges,79.76,37.27,,63.81,percent of total billed charges,37.27% of total billed charges,79.76,37.27,,63.81,percent of total billed charges,37.27% of total billed charges,35.24,75,,,fee schedule,75% of CMS fee schedule,35.24,75,,,fee schedule,75% of CMS fee schedule,46.98,100,,,fee schedule,100% of CMS fee schedule,46.98,100,,,fee schedule,100% of CMS fee schedule,35.24,75,,,fee schedule,75% of CMS fee schedule,35.24,75,,,fee schedule,75% of CMS fee schedule,46.98,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.6,40,,68.48,percent of total billed charges,40% of total billed charges,35.24,171.2,
CYSTATIN C,7012032,CDM,300,RC,82610,HCPCS,Outpatient,,,22.26,17.81,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.81,80,,14.25,percent of total billed charges,80% of total billed charges,8.3,37.27,,6.64,percent of total billed charges,37.27% of total billed charges,8.3,37.27,,6.64,percent of total billed charges,37.27% of total billed charges,8.3,37.27,,6.64,percent of total billed charges,37.27% of total billed charges,13.89,75,,,fee schedule,75% of CMS fee schedule,13.89,75,,,fee schedule,75% of CMS fee schedule,18.52,100,,,fee schedule,100% of CMS fee schedule,18.52,100,,,fee schedule,100% of CMS fee schedule,13.89,75,,,fee schedule,75% of CMS fee schedule,13.89,75,,,fee schedule,75% of CMS fee schedule,18.52,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.9,40,,7.12,percent of total billed charges,40% of total billed charges,8.3,18.52,
GAUCHERS DISEASE DNA,7000029,CDM,301,RC,81251,HCPCS,Outpatient,,,276,220.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.8,80,,176.64,percent of total billed charges,80% of total billed charges,102.87,37.27,,82.3,percent of total billed charges,37.27% of total billed charges,102.87,37.27,,82.3,percent of total billed charges,37.27% of total billed charges,102.87,37.27,,82.3,percent of total billed charges,37.27% of total billed charges,35.44,75,,,fee schedule,75% of CMS fee schedule,35.44,75,,,fee schedule,75% of CMS fee schedule,47.25,100,,,fee schedule,100% of CMS fee schedule,47.25,100,,,fee schedule,100% of CMS fee schedule,35.44,75,,,fee schedule,75% of CMS fee schedule,35.44,75,,,fee schedule,75% of CMS fee schedule,47.25,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.4,40,,88.32,percent of total billed charges,40% of total billed charges,35.44,220.8,
WESTNILE PCR SUPER Q,7000284,CDM,306,RC,87798,HCPCS,Outpatient,,,497,397.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,397.6,80,,318.08,percent of total billed charges,80% of total billed charges,185.23,37.27,,148.18,percent of total billed charges,37.27% of total billed charges,185.23,37.27,,148.18,percent of total billed charges,37.27% of total billed charges,185.23,37.27,,148.18,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198.8,40,,159.04,percent of total billed charges,40% of total billed charges,26.32,397.6,
TRYPTASE,7000029,CDM,301,RC,83520,HCPCS,Outpatient,,,316,252.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,12.95,75,,,fee schedule,75% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,12.95,252.8,
CHLAMYDIC TRACH IGM,7000029,CDM,301,RC,86632,HCPCS,Outpatient,,,41,32.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,9.51,75,,,fee schedule,75% of CMS fee schedule,9.51,75,,,fee schedule,75% of CMS fee schedule,12.68,100,,,fee schedule,100% of CMS fee schedule,12.68,100,,,fee schedule,100% of CMS fee schedule,9.51,75,,,fee schedule,75% of CMS fee schedule,9.51,75,,,fee schedule,75% of CMS fee schedule,12.68,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,9.51,32.8,
TESTOSTERONE WOMEN C,7000029,CDM,301,RC,84403,HCPCS,Outpatient,,,83,66.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,19.36,75,,,fee schedule,75% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.2,40,,26.56,percent of total billed charges,40% of total billed charges,19.36,66.4,
BORDETELLA PERT CULT,7000284,CDM,306,RC,87070,HCPCS,Outpatient,,,34,27.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,6.47,75,,,fee schedule,75% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,6.47,75,,,fee schedule,75% of CMS fee schedule,8.62,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,6.47,27.2,
FETAL SCREEN,7000177,CDM,305,RC,85461,HCPCS,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,7.02,75,,,fee schedule,75% of CMS fee schedule,7.02,75,,,fee schedule,75% of CMS fee schedule,9.36,100,,,fee schedule,100% of CMS fee schedule,9.36,100,,,fee schedule,100% of CMS fee schedule,7.02,75,,,fee schedule,75% of CMS fee schedule,7.02,75,,,fee schedule,75% of CMS fee schedule,9.36,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
"CANDIDA IGG,IGA:IGM",7000169,CDM,302,RC,86628,HCPCS,Outpatient,,,349,279.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,279.2,80,,223.36,percent of total billed charges,80% of total billed charges,130.07,37.27,,104.06,percent of total billed charges,37.27% of total billed charges,130.07,37.27,,104.06,percent of total billed charges,37.27% of total billed charges,130.07,37.27,,104.06,percent of total billed charges,37.27% of total billed charges,9.01,75,,,fee schedule,75% of CMS fee schedule,9.01,75,,,fee schedule,75% of CMS fee schedule,12.01,100,,,fee schedule,100% of CMS fee schedule,12.01,100,,,fee schedule,100% of CMS fee schedule,9.01,75,,,fee schedule,75% of CMS fee schedule,9.01,75,,,fee schedule,75% of CMS fee schedule,12.01,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,139.6,40,,111.68,percent of total billed charges,40% of total billed charges,9.01,279.2,
KLEIHAUER BETKE QUAN,7000177,CDM,305,RC,85460,HCPCS,Outpatient,,,73,58.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,5.8,75,,,fee schedule,75% of CMS fee schedule,5.8,75,,,fee schedule,75% of CMS fee schedule,7.73,100,,,fee schedule,100% of CMS fee schedule,7.73,100,,,fee schedule,100% of CMS fee schedule,5.8,75,,,fee schedule,75% of CMS fee schedule,5.8,75,,,fee schedule,75% of CMS fee schedule,7.73,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,5.8,58.4,
ANTICARDIOLIPIN IGA,7012032,CDM,300,RC,86147,HCPCS,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,19.09,75,,,fee schedule,75% of CMS fee schedule,19.09,75,,,fee schedule,75% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,19.09,75,,,fee schedule,75% of CMS fee schedule,19.09,75,,,fee schedule,75% of CMS fee schedule,25.45,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,19.09,58.4,
VITAMIN K,7000029,CDM,301,RC,84597,HCPCS,Outpatient,,,393,314.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.4,80,,251.52,percent of total billed charges,80% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% of total billed charges,10.29,75,,,fee schedule,75% of CMS fee schedule,10.29,75,,,fee schedule,75% of CMS fee schedule,13.72,100,,,fee schedule,100% of CMS fee schedule,13.72,100,,,fee schedule,100% of CMS fee schedule,10.29,75,,,fee schedule,75% of CMS fee schedule,10.29,75,,,fee schedule,75% of CMS fee schedule,13.72,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.2,40,,125.76,percent of total billed charges,40% of total billed charges,10.29,314.4,
ACYLARNITINE PROFILE,7012032,CDM,300,RC,82017,HCPCS,Outpatient,,,414,331.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,331.2,80,,264.96,percent of total billed charges,80% of total billed charges,154.3,37.27,,123.44,percent of total billed charges,37.27% of total billed charges,154.3,37.27,,123.44,percent of total billed charges,37.27% of total billed charges,154.3,37.27,,123.44,percent of total billed charges,37.27% of total billed charges,12.65,75,,,fee schedule,75% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165.6,40,,132.48,percent of total billed charges,40% of total billed charges,12.65,331.2,
THIOCYANATE LEVEL,7012032,CDM,300,RC,84430,HCPCS,Outpatient,,,286,228.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,8.72,75,,,fee schedule,75% of CMS fee schedule,8.72,75,,,fee schedule,75% of CMS fee schedule,11.63,100,,,fee schedule,100% of CMS fee schedule,11.63,100,,,fee schedule,100% of CMS fee schedule,8.72,75,,,fee schedule,75% of CMS fee schedule,8.72,75,,,fee schedule,75% of CMS fee schedule,11.63,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.4,40,,91.52,percent of total billed charges,40% of total billed charges,8.72,228.8,
DHEAS PEDIATRIC,7012032,CDM,300,RC,82627,HCPCS,Outpatient,,,129,103.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,48.08,37.27,,38.46,percent of total billed charges,37.27% of total billed charges,48.08,37.27,,38.46,percent of total billed charges,37.27% of total billed charges,48.08,37.27,,38.46,percent of total billed charges,37.27% of total billed charges,16.67,75,,,fee schedule,75% of CMS fee schedule,16.67,75,,,fee schedule,75% of CMS fee schedule,22.23,100,,,fee schedule,100% of CMS fee schedule,22.23,100,,,fee schedule,100% of CMS fee schedule,16.67,75,,,fee schedule,75% of CMS fee schedule,16.67,75,,,fee schedule,75% of CMS fee schedule,22.23,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.6,40,,41.28,percent of total billed charges,40% of total billed charges,16.67,103.2,
ESTRADIOL PEDIATRIC,7012032,CDM,300,RC,82670,HCPCS,Outpatient,,,196,156.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,20.96,75,,,fee schedule,75% of CMS fee schedule,20.96,75,,,fee schedule,75% of CMS fee schedule,27.94,100,,,fee schedule,100% of CMS fee schedule,27.94,100,,,fee schedule,100% of CMS fee schedule,20.96,75,,,fee schedule,75% of CMS fee schedule,20.96,75,,,fee schedule,75% of CMS fee schedule,27.94,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.4,40,,62.72,percent of total billed charges,40% of total billed charges,20.96,156.8,
FSH PEDIATRIC,7012032,CDM,300,RC,83001,HCPCS,Outpatient,,,83,66.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,13.94,75,,,fee schedule,75% of CMS fee schedule,13.94,75,,,fee schedule,75% of CMS fee schedule,18.58,100,,,fee schedule,100% of CMS fee schedule,18.58,100,,,fee schedule,100% of CMS fee schedule,13.94,75,,,fee schedule,75% of CMS fee schedule,13.94,75,,,fee schedule,75% of CMS fee schedule,18.58,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.2,40,,26.56,percent of total billed charges,40% of total billed charges,13.94,66.4,
LH PEDIATRIC,7012032,CDM,300,RC,83002,HCPCS,Outpatient,,,92,73.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,13.89,75,,,fee schedule,75% of CMS fee schedule,13.89,75,,,fee schedule,75% of CMS fee schedule,18.52,100,,,fee schedule,100% of CMS fee schedule,18.52,100,,,fee schedule,100% of CMS fee schedule,13.89,75,,,fee schedule,75% of CMS fee schedule,13.89,75,,,fee schedule,75% of CMS fee schedule,18.52,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,40,,29.44,percent of total billed charges,40% of total billed charges,13.89,73.6,
NOROVIRUS RT-PCR,7012032,CDM,300,RC,87798,HCPCS,Outpatient,,,252,201.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,80,,161.28,percent of total billed charges,80% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,40,,80.64,percent of total billed charges,40% of total billed charges,26.32,201.6,
ANTI-XA HEPARIN,7000177,CDM,305,RC,85520,HCPCS,Outpatient,,,211,168.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.8,80,,135.04,percent of total billed charges,80% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,9.82,75,,,fee schedule,75% of CMS fee schedule,9.82,75,,,fee schedule,75% of CMS fee schedule,13.09,100,,,fee schedule,100% of CMS fee schedule,13.09,100,,,fee schedule,100% of CMS fee schedule,9.82,75,,,fee schedule,75% of CMS fee schedule,9.82,75,,,fee schedule,75% of CMS fee schedule,13.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.4,40,,67.52,percent of total billed charges,40% of total billed charges,9.82,168.8,
COLTISOL TOTAL-SALIV,7012032,CDM,300,RC,82533,HCPCS,Outpatient,,,168,134.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,12.23,75,,,fee schedule,75% of CMS fee schedule,12.23,75,,,fee schedule,75% of CMS fee schedule,16.3,100,,,fee schedule,100% of CMS fee schedule,16.3,100,,,fee schedule,100% of CMS fee schedule,12.23,75,,,fee schedule,75% of CMS fee schedule,12.23,75,,,fee schedule,75% of CMS fee schedule,16.3,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,40,,53.76,percent of total billed charges,40% of total billed charges,12.23,134.4,
"CHROMATO,SGL VIGABAT",7012032,CDM,300,RC,82542,HCPCS,Outpatient,,,356,284.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,284.8,80,,227.84,percent of total billed charges,80% of total billed charges,132.68,37.27,,106.14,percent of total billed charges,37.27% of total billed charges,132.68,37.27,,106.14,percent of total billed charges,37.27% of total billed charges,132.68,37.27,,106.14,percent of total billed charges,37.27% of total billed charges,18.07,75,,,fee schedule,75% of CMS fee schedule,18.07,75,,,fee schedule,75% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,18.07,75,,,fee schedule,75% of CMS fee schedule,18.07,75,,,fee schedule,75% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.4,40,,113.92,percent of total billed charges,40% of total billed charges,18.07,284.8,
IMMUNO ANTIBD ML ISA,7012032,CDM,300,RC,83516,HCPCS,Outpatient,,,64,51.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,8.65,51.2,
TISS CUL BN MARROW,7012032,CDM,300,RC,88237,HCPCS,Outpatient,,,314,251.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,251.2,80,,200.96,percent of total billed charges,80% of total billed charges,117.03,37.27,,93.62,percent of total billed charges,37.27% of total billed charges,117.03,37.27,,93.62,percent of total billed charges,37.27% of total billed charges,117.03,37.27,,93.62,percent of total billed charges,37.27% of total billed charges,107.81,75,,,fee schedule,75% of CMS fee schedule,107.81,75,,,fee schedule,75% of CMS fee schedule,143.75,100,,,fee schedule,100% of CMS fee schedule,143.75,100,,,fee schedule,100% of CMS fee schedule,107.81,75,,,fee schedule,75% of CMS fee schedule,107.81,75,,,fee schedule,75% of CMS fee schedule,143.75,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.6,40,,100.48,percent of total billed charges,40% of total billed charges,107.81,251.2,
IMMUNO ELECTRO SERUM,7000169,CDM,302,RC,86334,HCPCS,Outpatient,,,109,87.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,16.76,75,,,fee schedule,75% of CMS fee schedule,16.76,75,,,fee schedule,75% of CMS fee schedule,22.34,100,,,fee schedule,100% of CMS fee schedule,22.34,100,,,fee schedule,100% of CMS fee schedule,16.76,75,,,fee schedule,75% of CMS fee schedule,16.76,75,,,fee schedule,75% of CMS fee schedule,22.34,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.6,40,,34.88,percent of total billed charges,40% of total billed charges,16.76,87.2,
ANDROSTENEDIONE LCMS,7012032,CDM,300,RC,82157,HCPCS,Outpatient,,,146,116.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,21.96,75,,,fee schedule,75% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,21.96,116.8,
BABESIA MICRON ICG-I,7012032,CDM,300,RC,86753,HCPCS,Outpatient,,,193,154.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.4,80,,123.52,percent of total billed charges,80% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,9.29,75,,,fee schedule,75% of CMS fee schedule,9.29,75,,,fee schedule,75% of CMS fee schedule,12.39,100,,,fee schedule,100% of CMS fee schedule,12.39,100,,,fee schedule,100% of CMS fee schedule,9.29,75,,,fee schedule,75% of CMS fee schedule,9.29,75,,,fee schedule,75% of CMS fee schedule,12.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.2,40,,61.76,percent of total billed charges,40% of total billed charges,9.29,154.4,
DR/DQ SINGLE ANTIGEN,7000169,CDM,302,RC,86816,HCPCS,Outpatient,,,137,109.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,51.06,37.27,,40.85,percent of total billed charges,37.27% of total billed charges,51.06,37.27,,40.85,percent of total billed charges,37.27% of total billed charges,51.06,37.27,,40.85,percent of total billed charges,37.27% of total billed charges,22.63,75,,,fee schedule,75% of CMS fee schedule,22.63,75,,,fee schedule,75% of CMS fee schedule,30.17,100,,,fee schedule,100% of CMS fee schedule,30.17,100,,,fee schedule,100% of CMS fee schedule,22.63,75,,,fee schedule,75% of CMS fee schedule,22.63,75,,,fee schedule,75% of CMS fee schedule,30.17,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.8,40,,43.84,percent of total billed charges,40% of total billed charges,22.63,109.6,
IMMUNO FOR ANALYL,7012032,CDM,300,RC,83516,HCPCS,Outpatient,,,166.2,132.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.96,80,,106.37,percent of total billed charges,80% of total billed charges,61.94,37.27,,49.55,percent of total billed charges,37.27% of total billed charges,61.94,37.27,,49.55,percent of total billed charges,37.27% of total billed charges,61.94,37.27,,49.55,percent of total billed charges,37.27% of total billed charges,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.48,40,,53.18,percent of total billed charges,40% of total billed charges,8.65,132.96,
TTGG-MAYO,7012032,CDM,300,RC,83516,HCPCS,Outpatient,,,166.2,132.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.96,80,,106.37,percent of total billed charges,80% of total billed charges,61.94,37.27,,49.55,percent of total billed charges,37.27% of total billed charges,61.94,37.27,,49.55,percent of total billed charges,37.27% of total billed charges,61.94,37.27,,49.55,percent of total billed charges,37.27% of total billed charges,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.48,40,,53.18,percent of total billed charges,40% of total billed charges,8.65,132.96,
"HHV-6 AB, IGG",7012032,CDM,300,RC,86790,HCPCS,Outpatient,,,21.9,17.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.52,80,,14.02,percent of total billed charges,80% of total billed charges,8.16,37.27,,6.53,percent of total billed charges,37.27% of total billed charges,8.16,37.27,,6.53,percent of total billed charges,37.27% of total billed charges,8.16,37.27,,6.53,percent of total billed charges,37.27% of total billed charges,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.76,40,,7.01,percent of total billed charges,40% of total billed charges,8.16,17.52,
GLYCOMARK,7012032,CDM,300,RC,84378,HCPCS,Outpatient,,,41.25,33.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33,80,,26.4,percent of total billed charges,80% of total billed charges,15.37,37.27,,12.3,percent of total billed charges,37.27% of total billed charges,15.37,37.27,,12.3,percent of total billed charges,37.27% of total billed charges,15.37,37.27,,12.3,percent of total billed charges,37.27% of total billed charges,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.5,40,,13.2,percent of total billed charges,40% of total billed charges,8.65,33,
TESTOSTERONE (PEDS),7012032,CDM,300,RC,84403,HCPCS,Outpatient,,,74.31,59.45,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.45,80,,47.56,percent of total billed charges,80% of total billed charges,27.7,37.27,,22.16,percent of total billed charges,37.27% of total billed charges,27.7,37.27,,22.16,percent of total billed charges,37.27% of total billed charges,27.7,37.27,,22.16,percent of total billed charges,37.27% of total billed charges,19.36,75,,,fee schedule,75% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,19.36,75,,,fee schedule,75% of CMS fee schedule,25.81,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.72,40,,23.78,percent of total billed charges,40% of total billed charges,19.36,59.45,
FREE PROTEIN S ANTIG,7000177,CDM,305,RC,85306,HCPCS,Outpatient,,,44.09,35.27,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.27,80,,28.22,percent of total billed charges,80% of total billed charges,16.43,37.27,,13.14,percent of total billed charges,37.27% of total billed charges,16.43,37.27,,13.14,percent of total billed charges,37.27% of total billed charges,16.43,37.27,,13.14,percent of total billed charges,37.27% of total billed charges,11.49,75,,,fee schedule,75% of CMS fee schedule,11.49,75,,,fee schedule,75% of CMS fee schedule,15.32,100,,,fee schedule,100% of CMS fee schedule,15.32,100,,,fee schedule,100% of CMS fee schedule,11.49,75,,,fee schedule,75% of CMS fee schedule,11.49,75,,,fee schedule,75% of CMS fee schedule,15.32,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.64,40,,14.11,percent of total billed charges,40% of total billed charges,11.49,35.27,
IGF1,7012032,CDM,300,RC,84305,HCPCS,Outpatient,,,56.49,45.19,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.19,80,,36.15,percent of total billed charges,80% of total billed charges,21.05,37.27,,16.84,percent of total billed charges,37.27% of total billed charges,21.05,37.27,,16.84,percent of total billed charges,37.27% of total billed charges,21.05,37.27,,16.84,percent of total billed charges,37.27% of total billed charges,15.95,75,,,fee schedule,75% of CMS fee schedule,15.95,75,,,fee schedule,75% of CMS fee schedule,21.26,100,,,fee schedule,100% of CMS fee schedule,21.26,100,,,fee schedule,100% of CMS fee schedule,15.95,75,,,fee schedule,75% of CMS fee schedule,15.95,75,,,fee schedule,75% of CMS fee schedule,21.26,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.6,40,,18.08,percent of total billed charges,40% of total billed charges,15.95,45.19,
CORD ART BLOOD GAS,7000029,CDM,301,RC,82803,HCPCS,Outpatient,,,168,134.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,19.55,75,,,fee schedule,75% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,40,,53.76,percent of total billed charges,40% of total billed charges,19.55,134.4,
17 HYDROXYPROEST PED,7039034,CDM,311,RC,83498,HCPCS,Outpatient,,,78.16,62.53,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.53,80,,50.02,percent of total billed charges,80% of total billed charges,29.13,37.27,,23.3,percent of total billed charges,37.27% of total billed charges,29.13,37.27,,23.3,percent of total billed charges,37.27% of total billed charges,29.13,37.27,,23.3,percent of total billed charges,37.27% of total billed charges,20.38,75,,,fee schedule,75% of CMS fee schedule,20.38,75,,,fee schedule,75% of CMS fee schedule,27.17,100,,,fee schedule,100% of CMS fee schedule,27.17,100,,,fee schedule,100% of CMS fee schedule,20.38,75,,,fee schedule,75% of CMS fee schedule,20.38,75,,,fee schedule,75% of CMS fee schedule,27.17,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.26,40,,25.01,percent of total billed charges,40% of total billed charges,20.38,62.53,
ORGANIC ACID URINE,7012032,CDM,300,RC,83919,HCPCS,Outpatient,,,47.37,37.90,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.9,80,,30.32,percent of total billed charges,80% of total billed charges,17.65,37.27,,14.12,percent of total billed charges,37.27% of total billed charges,17.65,37.27,,14.12,percent of total billed charges,37.27% of total billed charges,17.65,37.27,,14.12,percent of total billed charges,37.27% of total billed charges,12.34,75,,,fee schedule,75% of CMS fee schedule,12.34,75,,,fee schedule,75% of CMS fee schedule,16.45,100,,,fee schedule,100% of CMS fee schedule,16.45,100,,,fee schedule,100% of CMS fee schedule,12.34,75,,,fee schedule,75% of CMS fee schedule,12.34,75,,,fee schedule,75% of CMS fee schedule,16.45,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.95,40,,15.16,percent of total billed charges,40% of total billed charges,12.34,37.9,
AMINO ACID PRO QT PL,7012032,CDM,300,RC,82139,HCPCS,Outpatient,,,48.54,38.83,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.83,80,,31.06,percent of total billed charges,80% of total billed charges,18.09,37.27,,14.47,percent of total billed charges,37.27% of total billed charges,18.09,37.27,,14.47,percent of total billed charges,37.27% of total billed charges,18.09,37.27,,14.47,percent of total billed charges,37.27% of total billed charges,12.65,75,,,fee schedule,75% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,12.65,75,,,fee schedule,75% of CMS fee schedule,16.87,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.42,40,,15.54,percent of total billed charges,40% of total billed charges,12.65,38.83,
"ORGANIC ACIDS,PLASMA",7012032,CDM,300,RC,83918,HCPCS,Outpatient,,,47.37,37.90,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.9,80,,30.32,percent of total billed charges,80% of total billed charges,17.65,37.27,,14.12,percent of total billed charges,37.27% of total billed charges,17.65,37.27,,14.12,percent of total billed charges,37.27% of total billed charges,17.65,37.27,,14.12,percent of total billed charges,37.27% of total billed charges,17.7,75,,,fee schedule,75% of CMS fee schedule,17.7,75,,,fee schedule,75% of CMS fee schedule,23.6,100,,,fee schedule,100% of CMS fee schedule,23.6,100,,,fee schedule,100% of CMS fee schedule,17.7,75,,,fee schedule,75% of CMS fee schedule,17.7,75,,,fee schedule,75% of CMS fee schedule,23.6,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.95,40,,15.16,percent of total billed charges,40% of total billed charges,17.65,37.9,
ADIPONECTIN,7012032,CDM,300,RC,83520,HCPCS,Outpatient,,,37.26,29.81,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.81,80,,23.85,percent of total billed charges,80% of total billed charges,13.89,37.27,,11.11,percent of total billed charges,37.27% of total billed charges,13.89,37.27,,11.11,percent of total billed charges,37.27% of total billed charges,13.89,37.27,,11.11,percent of total billed charges,37.27% of total billed charges,12.95,75,,,fee schedule,75% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.9,40,,11.92,percent of total billed charges,40% of total billed charges,12.95,29.81,
HSV-2 IGG,7000169,CDM,302,RC,86696,HCPCS,Outpatient,,,55.71,44.57,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.57,80,,35.66,percent of total billed charges,80% of total billed charges,20.76,37.27,,16.61,percent of total billed charges,37.27% of total billed charges,20.76,37.27,,16.61,percent of total billed charges,37.27% of total billed charges,20.76,37.27,,16.61,percent of total billed charges,37.27% of total billed charges,14.51,75,,,fee schedule,75% of CMS fee schedule,14.51,75,,,fee schedule,75% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,14.51,75,,,fee schedule,75% of CMS fee schedule,14.51,75,,,fee schedule,75% of CMS fee schedule,19.35,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.28,40,,17.82,percent of total billed charges,40% of total billed charges,14.51,44.57,
VORICONOZOLE,7012032,CDM,300,RC,83789,HCPCS,Outpatient,,,51.96,41.57,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.57,80,,33.26,percent of total billed charges,80% of total billed charges,19.37,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.37,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.37,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,18.08,75,,,fee schedule,75% of CMS fee schedule,18.08,75,,,fee schedule,75% of CMS fee schedule,24.11,100,,,fee schedule,100% of CMS fee schedule,24.11,100,,,fee schedule,100% of CMS fee schedule,18.08,75,,,fee schedule,75% of CMS fee schedule,18.08,75,,,fee schedule,75% of CMS fee schedule,24.11,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.78,40,,16.62,percent of total billed charges,40% of total billed charges,18.08,41.57,
CREATININE,7000029,CDM,301,RC,82565,HCPCS,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,3.84,75,,,fee schedule,75% of CMS fee schedule,3.84,75,,,fee schedule,75% of CMS fee schedule,5.12,100,,,fee schedule,100% of CMS fee schedule,5.12,100,,,fee schedule,100% of CMS fee schedule,3.84,75,,,fee schedule,75% of CMS fee schedule,3.84,75,,,fee schedule,75% of CMS fee schedule,5.12,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,3.84,22.4,
CREATININE,7000029,CDM,301,RC,82565,HCPCS,Outpatient,,,22.77,18.22,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.22,80,,14.58,percent of total billed charges,80% of total billed charges,8.49,37.27,,6.79,percent of total billed charges,37.27% of total billed charges,8.49,37.27,,6.79,percent of total billed charges,37.27% of total billed charges,8.49,37.27,,6.79,percent of total billed charges,37.27% of total billed charges,3.84,75,,,fee schedule,75% of CMS fee schedule,3.84,75,,,fee schedule,75% of CMS fee schedule,5.12,100,,,fee schedule,100% of CMS fee schedule,5.12,100,,,fee schedule,100% of CMS fee schedule,3.84,75,,,fee schedule,75% of CMS fee schedule,3.84,75,,,fee schedule,75% of CMS fee schedule,5.12,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.11,40,,7.29,percent of total billed charges,40% of total billed charges,3.84,18.22,
OCCULT BLOOD 1,7012032,CDM,300,RC,82272,HCPCS,Outpatient,,,7.89,6.31,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.31,80,,5.05,percent of total billed charges,80% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% of total billed charges,3.17,75,,,fee schedule,75% of CMS fee schedule,3.17,75,,,fee schedule,75% of CMS fee schedule,4.23,100,,,fee schedule,100% of CMS fee schedule,4.23,100,,,fee schedule,100% of CMS fee schedule,3.17,75,,,fee schedule,75% of CMS fee schedule,3.17,75,,,fee schedule,75% of CMS fee schedule,4.23,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,40,,2.53,percent of total billed charges,40% of total billed charges,2.94,6.31,
PEDIGFBP3,7012032,CDM,300,RC,83519,HCPCS,Outpatient,,,36.8,29.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.44,80,,23.55,percent of total billed charges,80% of total billed charges,13.72,37.27,,10.98,percent of total billed charges,37.27% of total billed charges,13.72,37.27,,10.98,percent of total billed charges,37.27% of total billed charges,13.72,37.27,,10.98,percent of total billed charges,37.27% of total billed charges,13.8,75,,,fee schedule,75% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,40,,11.78,percent of total billed charges,40% of total billed charges,13.72,29.44,
PEDIATRIC CORTISOL,7012032,CDM,300,RC,82533,HCPCS,Outpatient,,,74.25,59.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.4,80,,47.52,percent of total billed charges,80% of total billed charges,27.67,37.27,,22.14,percent of total billed charges,37.27% of total billed charges,27.67,37.27,,22.14,percent of total billed charges,37.27% of total billed charges,27.67,37.27,,22.14,percent of total billed charges,37.27% of total billed charges,12.23,75,,,fee schedule,75% of CMS fee schedule,12.23,75,,,fee schedule,75% of CMS fee schedule,16.3,100,,,fee schedule,100% of CMS fee schedule,16.3,100,,,fee schedule,100% of CMS fee schedule,12.23,75,,,fee schedule,75% of CMS fee schedule,12.23,75,,,fee schedule,75% of CMS fee schedule,16.3,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.7,40,,23.76,percent of total billed charges,40% of total billed charges,12.23,59.4,
IGFBP-2,7012032,CDM,300,RC,83519,HCPCS,Outpatient,,,75.75,60.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.6,80,,48.48,percent of total billed charges,80% of total billed charges,28.23,37.27,,22.58,percent of total billed charges,37.27% of total billed charges,28.23,37.27,,22.58,percent of total billed charges,37.27% of total billed charges,28.23,37.27,,22.58,percent of total billed charges,37.27% of total billed charges,13.8,75,,,fee schedule,75% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,13.8,75,,,fee schedule,75% of CMS fee schedule,18.4,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.3,40,,24.24,percent of total billed charges,40% of total billed charges,13.8,60.6,
PEDIATRIC GROWTH HOR,7012032,CDM,300,RC,83003,HCPCS,Outpatient,,,72,57.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,80,,46.08,percent of total billed charges,80% of total billed charges,26.83,37.27,,21.46,percent of total billed charges,37.27% of total billed charges,26.83,37.27,,21.46,percent of total billed charges,37.27% of total billed charges,26.83,37.27,,21.46,percent of total billed charges,37.27% of total billed charges,12.5,75,,,fee schedule,75% of CMS fee schedule,12.5,75,,,fee schedule,75% of CMS fee schedule,16.67,100,,,fee schedule,100% of CMS fee schedule,16.67,100,,,fee schedule,100% of CMS fee schedule,12.5,75,,,fee schedule,75% of CMS fee schedule,12.5,75,,,fee schedule,75% of CMS fee schedule,16.67,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,40,,23.04,percent of total billed charges,40% of total billed charges,12.5,57.6,
WEST NILE VIRUS,7000169,CDM,302,RC,86789,HCPCS,Outpatient,,,49.1,39.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.28,80,,31.42,percent of total billed charges,80% of total billed charges,18.3,37.27,,14.64,percent of total billed charges,37.27% of total billed charges,18.3,37.27,,14.64,percent of total billed charges,37.27% of total billed charges,18.3,37.27,,14.64,percent of total billed charges,37.27% of total billed charges,10.79,75,,,fee schedule,75% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,10.79,75,,,fee schedule,75% of CMS fee schedule,14.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.64,40,,15.71,percent of total billed charges,40% of total billed charges,10.79,39.28,
CSF-VIRALCULTURE,7012032,CDM,300,RC,87252,HCPCS,Outpatient,,,56.57,45.26,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.26,80,,36.21,percent of total billed charges,80% of total billed charges,21.08,37.27,,16.86,percent of total billed charges,37.27% of total billed charges,21.08,37.27,,16.86,percent of total billed charges,37.27% of total billed charges,21.08,37.27,,16.86,percent of total billed charges,37.27% of total billed charges,19.55,75,,,fee schedule,75% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,19.55,75,,,fee schedule,75% of CMS fee schedule,26.07,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.63,40,,18.1,percent of total billed charges,40% of total billed charges,19.55,45.26,
CHROMOSOME ANALYSES,7012032,CDM,300,RC,88261,HCPCS,Outpatient,,,427.5,342.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,342,80,,273.6,percent of total billed charges,80% of total billed charges,159.33,37.27,,127.46,percent of total billed charges,37.27% of total billed charges,159.33,37.27,,127.46,percent of total billed charges,37.27% of total billed charges,159.33,37.27,,127.46,percent of total billed charges,37.27% of total billed charges,198.26,75,,,fee schedule,75% of CMS fee schedule,198.26,75,,,fee schedule,75% of CMS fee schedule,264.34,100,,,fee schedule,100% of CMS fee schedule,264.34,100,,,fee schedule,100% of CMS fee schedule,198.26,75,,,fee schedule,75% of CMS fee schedule,198.26,75,,,fee schedule,75% of CMS fee schedule,264.34,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171,40,,136.8,percent of total billed charges,40% of total billed charges,159.33,342,
SELENIUM,7012032,CDM,300,RC,84255,HCPCS,Outpatient,,,45.53,36.42,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.42,80,,29.14,percent of total billed charges,80% of total billed charges,16.97,37.27,,13.58,percent of total billed charges,37.27% of total billed charges,16.97,37.27,,13.58,percent of total billed charges,37.27% of total billed charges,16.97,37.27,,13.58,percent of total billed charges,37.27% of total billed charges,19.15,75,,,fee schedule,75% of CMS fee schedule,19.15,75,,,fee schedule,75% of CMS fee schedule,25.53,100,,,fee schedule,100% of CMS fee schedule,25.53,100,,,fee schedule,100% of CMS fee schedule,19.15,75,,,fee schedule,75% of CMS fee schedule,19.15,75,,,fee schedule,75% of CMS fee schedule,25.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.21,40,,14.57,percent of total billed charges,40% of total billed charges,16.97,36.42,
CHROMOSOME ANALYSIS,7012032,CDM,300,RC,88280,HCPCS,Outpatient,,,197.18,157.74,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.74,80,,126.19,percent of total billed charges,80% of total billed charges,73.49,37.27,,58.79,percent of total billed charges,37.27% of total billed charges,73.49,37.27,,58.79,percent of total billed charges,37.27% of total billed charges,73.49,37.27,,58.79,percent of total billed charges,37.27% of total billed charges,25.1,75,,,fee schedule,75% of CMS fee schedule,25.1,75,,,fee schedule,75% of CMS fee schedule,33.47,100,,,fee schedule,100% of CMS fee schedule,33.47,100,,,fee schedule,100% of CMS fee schedule,25.1,75,,,fee schedule,75% of CMS fee schedule,25.1,75,,,fee schedule,75% of CMS fee schedule,33.47,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.87,40,,63.1,percent of total billed charges,40% of total billed charges,25.1,157.74,
VIT D25(OH)PEDIATRIC,7012032,CDM,300,RC,82306,HCPCS,Outpatient,,,115.17,92.14,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.14,80,,73.71,percent of total billed charges,80% of total billed charges,42.92,37.27,,34.34,percent of total billed charges,37.27% of total billed charges,42.92,37.27,,34.34,percent of total billed charges,37.27% of total billed charges,42.92,37.27,,34.34,percent of total billed charges,37.27% of total billed charges,22.2,75,,,fee schedule,75% of CMS fee schedule,22.2,75,,,fee schedule,75% of CMS fee schedule,29.6,100,,,fee schedule,100% of CMS fee schedule,29.6,100,,,fee schedule,100% of CMS fee schedule,22.2,75,,,fee schedule,75% of CMS fee schedule,22.2,75,,,fee schedule,75% of CMS fee schedule,29.6,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.07,40,,36.86,percent of total billed charges,40% of total billed charges,22.2,92.14,
HIV-2,7000169,CDM,302,RC,86702,HCPCS,Outpatient,,,36.3,29.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.04,80,,23.23,percent of total billed charges,80% of total billed charges,13.53,37.27,,10.82,percent of total billed charges,37.27% of total billed charges,13.53,37.27,,10.82,percent of total billed charges,37.27% of total billed charges,13.53,37.27,,10.82,percent of total billed charges,37.27% of total billed charges,10.14,75,,,fee schedule,75% of CMS fee schedule,10.14,75,,,fee schedule,75% of CMS fee schedule,13.52,100,,,fee schedule,100% of CMS fee schedule,13.52,100,,,fee schedule,100% of CMS fee schedule,10.14,75,,,fee schedule,75% of CMS fee schedule,10.14,75,,,fee schedule,75% of CMS fee schedule,13.52,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.52,40,,11.62,percent of total billed charges,40% of total billed charges,10.14,29.04,
DES-G-CARB PROTHROMB,7012032,CDM,300,RC,83951,HCPCS,Outpatient,,,258,206.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,206.4,80,,165.12,percent of total billed charges,80% of total billed charges,96.16,37.27,,76.93,percent of total billed charges,37.27% of total billed charges,96.16,37.27,,76.93,percent of total billed charges,37.27% of total billed charges,96.16,37.27,,76.93,percent of total billed charges,37.27% of total billed charges,48.31,75,,,fee schedule,75% of CMS fee schedule,48.31,75,,,fee schedule,75% of CMS fee schedule,64.41,100,,,fee schedule,100% of CMS fee schedule,64.41,100,,,fee schedule,100% of CMS fee schedule,48.31,75,,,fee schedule,75% of CMS fee schedule,48.31,75,,,fee schedule,75% of CMS fee schedule,64.41,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.2,40,,82.56,percent of total billed charges,40% of total billed charges,48.31,206.4,
PED II DESOXYCORTISO,7012032,CDM,300,RC,82634,HCPCS,Outpatient,,,100.6,80.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.48,80,,64.38,percent of total billed charges,80% of total billed charges,37.49,37.27,,29.99,percent of total billed charges,37.27% of total billed charges,37.49,37.27,,29.99,percent of total billed charges,37.27% of total billed charges,37.49,37.27,,29.99,percent of total billed charges,37.27% of total billed charges,21.96,75,,,fee schedule,75% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,21.96,75,,,fee schedule,75% of CMS fee schedule,29.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.24,40,,32.19,percent of total billed charges,40% of total billed charges,21.96,80.48,
CHOLESTEROL CRYSTALS,7012032,CDM,300,RC,89060,HCPCS,Outpatient,,,88.13,70.50,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.5,80,,56.4,percent of total billed charges,80% of total billed charges,32.85,37.27,,26.28,percent of total billed charges,37.27% of total billed charges,32.85,37.27,,26.28,percent of total billed charges,37.27% of total billed charges,32.85,37.27,,26.28,percent of total billed charges,37.27% of total billed charges,5.5,75,,,fee schedule,75% of CMS fee schedule,5.5,75,,,fee schedule,75% of CMS fee schedule,7.33,100,,,fee schedule,100% of CMS fee schedule,7.33,100,,,fee schedule,100% of CMS fee schedule,5.5,75,,,fee schedule,75% of CMS fee schedule,5.5,75,,,fee schedule,75% of CMS fee schedule,7.33,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.25,40,,28.2,percent of total billed charges,40% of total billed charges,5.5,70.5,
"ZINC,RBC",7000029,CDM,301,RC,84630,HCPCS,Outpatient,,,138.75,111.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111,80,,88.8,percent of total billed charges,80% of total billed charges,51.71,37.27,,41.37,percent of total billed charges,37.27% of total billed charges,51.71,37.27,,41.37,percent of total billed charges,37.27% of total billed charges,51.71,37.27,,41.37,percent of total billed charges,37.27% of total billed charges,8.54,75,,,fee schedule,75% of CMS fee schedule,8.54,75,,,fee schedule,75% of CMS fee schedule,11.39,100,,,fee schedule,100% of CMS fee schedule,11.39,100,,,fee schedule,100% of CMS fee schedule,8.54,75,,,fee schedule,75% of CMS fee schedule,8.54,75,,,fee schedule,75% of CMS fee schedule,11.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.5,40,,44.4,percent of total billed charges,40% of total billed charges,8.54,111,
"ZINC,PLASMA/SERUM",7012032,CDM,300,RC,84630,HCPCS,Outpatient,,,39.13,31.30,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.3,80,,25.04,percent of total billed charges,80% of total billed charges,14.58,37.27,,11.66,percent of total billed charges,37.27% of total billed charges,14.58,37.27,,11.66,percent of total billed charges,37.27% of total billed charges,14.58,37.27,,11.66,percent of total billed charges,37.27% of total billed charges,8.54,75,,,fee schedule,75% of CMS fee schedule,8.54,75,,,fee schedule,75% of CMS fee schedule,11.39,100,,,fee schedule,100% of CMS fee schedule,11.39,100,,,fee schedule,100% of CMS fee schedule,8.54,75,,,fee schedule,75% of CMS fee schedule,8.54,75,,,fee schedule,75% of CMS fee schedule,11.39,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.65,40,,12.52,percent of total billed charges,40% of total billed charges,8.54,31.3,
THYROTROPIN LEVEL,7012032,CDM,300,RC,83520,HCPCS,Outpatient,,,25.5,20.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,80,,16.32,percent of total billed charges,80% of total billed charges,9.5,37.27,,7.6,percent of total billed charges,37.27% of total billed charges,9.5,37.27,,7.6,percent of total billed charges,37.27% of total billed charges,9.5,37.27,,7.6,percent of total billed charges,37.27% of total billed charges,12.95,75,,,fee schedule,75% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.2,40,,8.16,percent of total billed charges,40% of total billed charges,9.5,20.4,
COLL FEE MATERNITY21,7012032,CDM,300,RC,36415,HCPCS,Outpatient,,,25,20.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,6.62,20,
CHROMATOGRAPHY,7012032,CDM,300,RC,83021,HCPCS,Outpatient,,,62.4,49.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.92,80,,39.94,percent of total billed charges,80% of total billed charges,23.26,37.27,,18.61,percent of total billed charges,37.27% of total billed charges,23.26,37.27,,18.61,percent of total billed charges,37.27% of total billed charges,23.26,37.27,,18.61,percent of total billed charges,37.27% of total billed charges,13.55,75,,,fee schedule,75% of CMS fee schedule,13.55,75,,,fee schedule,75% of CMS fee schedule,18.06,100,,,fee schedule,100% of CMS fee schedule,18.06,100,,,fee schedule,100% of CMS fee schedule,13.55,75,,,fee schedule,75% of CMS fee schedule,13.55,75,,,fee schedule,75% of CMS fee schedule,18.06,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,40,,19.97,percent of total billed charges,40% of total billed charges,13.55,49.92,
CHROMIUM,7012032,CDM,300,RC,82495,HCPCS,Outpatient,,,69.7,55.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.76,80,,44.61,percent of total billed charges,80% of total billed charges,25.98,37.27,,20.78,percent of total billed charges,37.27% of total billed charges,25.98,37.27,,20.78,percent of total billed charges,37.27% of total billed charges,25.98,37.27,,20.78,percent of total billed charges,37.27% of total billed charges,15.21,75,,,fee schedule,75% of CMS fee schedule,15.21,75,,,fee schedule,75% of CMS fee schedule,20.28,100,,,fee schedule,100% of CMS fee schedule,20.28,100,,,fee schedule,100% of CMS fee schedule,15.21,75,,,fee schedule,75% of CMS fee schedule,15.21,75,,,fee schedule,75% of CMS fee schedule,20.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.88,40,,22.3,percent of total billed charges,40% of total billed charges,15.21,55.76,
NICKEL,7012032,CDM,300,RC,83885,HCPCS,Outpatient,,,84.2,67.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.36,80,,53.89,percent of total billed charges,80% of total billed charges,31.38,37.27,,25.1,percent of total billed charges,37.27% of total billed charges,31.38,37.27,,25.1,percent of total billed charges,37.27% of total billed charges,31.38,37.27,,25.1,percent of total billed charges,37.27% of total billed charges,18.38,75,,,fee schedule,75% of CMS fee schedule,18.38,75,,,fee schedule,75% of CMS fee schedule,24.51,100,,,fee schedule,100% of CMS fee schedule,24.51,100,,,fee schedule,100% of CMS fee schedule,18.38,75,,,fee schedule,75% of CMS fee schedule,18.38,75,,,fee schedule,75% of CMS fee schedule,24.51,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.68,40,,26.94,percent of total billed charges,40% of total billed charges,18.38,67.36,
COBALT,7012032,CDM,300,RC,83018,HCPCS,Outpatient,,,29.2,23.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,80,,18.69,percent of total billed charges,80% of total billed charges,10.88,37.27,,8.7,percent of total billed charges,37.27% of total billed charges,10.88,37.27,,8.7,percent of total billed charges,37.27% of total billed charges,10.88,37.27,,8.7,percent of total billed charges,37.27% of total billed charges,16.47,75,,,fee schedule,75% of CMS fee schedule,16.47,75,,,fee schedule,75% of CMS fee schedule,21.96,100,,,fee schedule,100% of CMS fee schedule,21.96,100,,,fee schedule,100% of CMS fee schedule,16.47,75,,,fee schedule,75% of CMS fee schedule,16.47,75,,,fee schedule,75% of CMS fee schedule,21.96,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.68,40,,9.34,percent of total billed charges,40% of total billed charges,10.88,23.36,
MOLYBDENUM,7012032,CDM,300,RC,83018,HCPCS,Outpatient,,,29.2,23.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,80,,18.69,percent of total billed charges,80% of total billed charges,10.88,37.27,,8.7,percent of total billed charges,37.27% of total billed charges,10.88,37.27,,8.7,percent of total billed charges,37.27% of total billed charges,10.88,37.27,,8.7,percent of total billed charges,37.27% of total billed charges,16.47,75,,,fee schedule,75% of CMS fee schedule,16.47,75,,,fee schedule,75% of CMS fee schedule,21.96,100,,,fee schedule,100% of CMS fee schedule,21.96,100,,,fee schedule,100% of CMS fee schedule,16.47,75,,,fee schedule,75% of CMS fee schedule,16.47,75,,,fee schedule,75% of CMS fee schedule,21.96,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.68,40,,9.34,percent of total billed charges,40% of total billed charges,10.88,23.36,
ANTI SACCHAROMYCES,7000169,CDM,302,RC,86671,HCPCS,Outpatient,,,58.84,47.07,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.07,80,,37.66,percent of total billed charges,80% of total billed charges,21.93,37.27,,17.54,percent of total billed charges,37.27% of total billed charges,21.93,37.27,,17.54,percent of total billed charges,37.27% of total billed charges,21.93,37.27,,17.54,percent of total billed charges,37.27% of total billed charges,9.19,75,,,fee schedule,75% of CMS fee schedule,9.19,75,,,fee schedule,75% of CMS fee schedule,12.25,100,,,fee schedule,100% of CMS fee schedule,12.25,100,,,fee schedule,100% of CMS fee schedule,9.19,75,,,fee schedule,75% of CMS fee schedule,9.19,75,,,fee schedule,75% of CMS fee schedule,12.25,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.54,40,,18.83,percent of total billed charges,40% of total billed charges,9.19,47.07,
PG(PHOSPHATIDYGLYCER,7012032,CDM,300,RC,84081,HCPCS,Outpatient,,,81.75,65.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.4,80,,52.32,percent of total billed charges,80% of total billed charges,30.47,37.27,,24.38,percent of total billed charges,37.27% of total billed charges,30.47,37.27,,24.38,percent of total billed charges,37.27% of total billed charges,30.47,37.27,,24.38,percent of total billed charges,37.27% of total billed charges,12.39,75,,,fee schedule,75% of CMS fee schedule,12.39,75,,,fee schedule,75% of CMS fee schedule,16.52,100,,,fee schedule,100% of CMS fee schedule,16.52,100,,,fee schedule,100% of CMS fee schedule,12.39,75,,,fee schedule,75% of CMS fee schedule,12.39,75,,,fee schedule,75% of CMS fee schedule,16.52,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.7,40,,26.16,percent of total billed charges,40% of total billed charges,12.39,65.4,
CREAT CLEARANCE 12HR,7012032,CDM,300,RC,82575,HCPCS,Outpatient,,,34.75,27.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.8,80,,22.24,percent of total billed charges,80% of total billed charges,12.95,37.27,,10.36,percent of total billed charges,37.27% of total billed charges,12.95,37.27,,10.36,percent of total billed charges,37.27% of total billed charges,12.95,37.27,,10.36,percent of total billed charges,37.27% of total billed charges,7.1,75,,,fee schedule,75% of CMS fee schedule,7.1,75,,,fee schedule,75% of CMS fee schedule,9.46,100,,,fee schedule,100% of CMS fee schedule,9.46,100,,,fee schedule,100% of CMS fee schedule,7.1,75,,,fee schedule,75% of CMS fee schedule,7.1,75,,,fee schedule,75% of CMS fee schedule,9.46,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.9,40,,11.12,percent of total billed charges,40% of total billed charges,7.1,27.8,
TOTAL PRTN URINE 12H,7012032,CDM,300,RC,84156,HCPCS,Outpatient,,,12.6,10.08,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,80,,8.06,percent of total billed charges,80% of total billed charges,4.7,37.27,,3.76,percent of total billed charges,37.27% of total billed charges,4.7,37.27,,3.76,percent of total billed charges,37.27% of total billed charges,4.7,37.27,,3.76,percent of total billed charges,37.27% of total billed charges,2.75,75,,,fee schedule,75% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,2.75,75,,,fee schedule,75% of CMS fee schedule,3.67,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,40,,4.03,percent of total billed charges,40% of total billed charges,2.75,10.08,
PLASMA RENINE ACTI,7012032,CDM,300,RC,84244,HCPCS,Outpatient,,,75.03,60.02,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.02,80,,48.02,percent of total billed charges,80% of total billed charges,27.96,37.27,,22.37,percent of total billed charges,37.27% of total billed charges,27.96,37.27,,22.37,percent of total billed charges,37.27% of total billed charges,27.96,37.27,,22.37,percent of total billed charges,37.27% of total billed charges,16.49,75,,,fee schedule,75% of CMS fee schedule,16.49,75,,,fee schedule,75% of CMS fee schedule,21.99,100,,,fee schedule,100% of CMS fee schedule,21.99,100,,,fee schedule,100% of CMS fee schedule,16.49,75,,,fee schedule,75% of CMS fee schedule,16.49,75,,,fee schedule,75% of CMS fee schedule,21.99,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.01,40,,24.01,percent of total billed charges,40% of total billed charges,16.49,60.02,
ID BY NON-IMMUNOLOGI,7000284,CDM,306,RC,87255,HCPCS,Outpatient,,,116.38,93.10,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.1,80,,74.48,percent of total billed charges,80% of total billed charges,43.37,37.27,,34.7,percent of total billed charges,37.27% of total billed charges,43.37,37.27,,34.7,percent of total billed charges,37.27% of total billed charges,43.37,37.27,,34.7,percent of total billed charges,37.27% of total billed charges,25.4,75,,,fee schedule,75% of CMS fee schedule,25.4,75,,,fee schedule,75% of CMS fee schedule,33.86,100,,,fee schedule,100% of CMS fee schedule,33.86,100,,,fee schedule,100% of CMS fee schedule,25.4,75,,,fee schedule,75% of CMS fee schedule,25.4,75,,,fee schedule,75% of CMS fee schedule,33.86,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.55,40,,37.24,percent of total billed charges,40% of total billed charges,25.4,93.1,
TISSUE TRANSGLU IGG,7000169,CDM,302,RC,86364,HCPCS,Outpatient,,,54.31,43.45,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.45,80,,34.76,percent of total billed charges,80% of total billed charges,20.24,37.27,,16.19,percent of total billed charges,37.27% of total billed charges,20.24,37.27,,16.19,percent of total billed charges,37.27% of total billed charges,20.24,37.27,,16.19,percent of total billed charges,37.27% of total billed charges,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.72,40,,17.38,percent of total billed charges,40% of total billed charges,8.65,43.45,
PEDIATRIC PROLACTIN,7012032,CDM,300,RC,84146,HCPCS,Outpatient,,,91.26,73.01,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.01,80,,58.41,percent of total billed charges,80% of total billed charges,34.01,37.27,,27.21,percent of total billed charges,37.27% of total billed charges,34.01,37.27,,27.21,percent of total billed charges,37.27% of total billed charges,34.01,37.27,,27.21,percent of total billed charges,37.27% of total billed charges,14.54,75,,,fee schedule,75% of CMS fee schedule,14.54,75,,,fee schedule,75% of CMS fee schedule,19.38,100,,,fee schedule,100% of CMS fee schedule,19.38,100,,,fee schedule,100% of CMS fee schedule,14.54,75,,,fee schedule,75% of CMS fee schedule,14.54,75,,,fee schedule,75% of CMS fee schedule,19.38,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.5,40,,29.2,percent of total billed charges,40% of total billed charges,14.54,73.01,
PROTOPORPHIN,7012032,CDM,300,RC,84202,HCPCS,Outpatient,,,67.56,54.05,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.05,80,,43.24,percent of total billed charges,80% of total billed charges,25.18,37.27,,20.14,percent of total billed charges,37.27% of total billed charges,25.18,37.27,,20.14,percent of total billed charges,37.27% of total billed charges,25.18,37.27,,20.14,percent of total billed charges,37.27% of total billed charges,10.76,75,,,fee schedule,75% of CMS fee schedule,10.76,75,,,fee schedule,75% of CMS fee schedule,14.35,100,,,fee schedule,100% of CMS fee schedule,14.35,100,,,fee schedule,100% of CMS fee schedule,10.76,75,,,fee schedule,75% of CMS fee schedule,10.76,75,,,fee schedule,75% of CMS fee schedule,14.35,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.02,40,,21.62,percent of total billed charges,40% of total billed charges,10.76,54.05,
MRSA-PCR,7000284,CDM,306,RC,87641,HCPCS,Outpatient,,,168.84,135.07,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.07,80,,108.06,percent of total billed charges,80% of total billed charges,62.93,37.27,,50.34,percent of total billed charges,37.27% of total billed charges,62.93,37.27,,50.34,percent of total billed charges,37.27% of total billed charges,62.93,37.27,,50.34,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.54,40,,54.03,percent of total billed charges,40% of total billed charges,26.32,135.07,
JAK2V617F,7000029,CDM,301,RC,81270,HCPCS,Outpatient,,,437.71,350.17,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.17,80,,280.14,percent of total billed charges,80% of total billed charges,163.13,37.27,,130.5,percent of total billed charges,37.27% of total billed charges,163.13,37.27,,130.5,percent of total billed charges,37.27% of total billed charges,163.13,37.27,,130.5,percent of total billed charges,37.27% of total billed charges,68.75,75,,,fee schedule,75% of CMS fee schedule,68.75,75,,,fee schedule,75% of CMS fee schedule,91.66,100,,,fee schedule,100% of CMS fee schedule,91.66,100,,,fee schedule,100% of CMS fee schedule,68.75,75,,,fee schedule,75% of CMS fee schedule,68.75,75,,,fee schedule,75% of CMS fee schedule,91.66,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.08,40,,140.06,percent of total billed charges,40% of total billed charges,68.75,350.17,
URINE-PNEUMOCOCCUS,7012032,CDM,300,RC,87899,HCPCS,Outpatient,,,57.72,46.18,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.18,80,,36.94,percent of total billed charges,80% of total billed charges,21.51,37.27,,17.21,percent of total billed charges,37.27% of total billed charges,21.51,37.27,,17.21,percent of total billed charges,37.27% of total billed charges,21.51,37.27,,17.21,percent of total billed charges,37.27% of total billed charges,12.05,75,,,fee schedule,75% of CMS fee schedule,12.05,75,,,fee schedule,75% of CMS fee schedule,16.07,100,,,fee schedule,100% of CMS fee schedule,16.07,100,,,fee schedule,100% of CMS fee schedule,12.05,75,,,fee schedule,75% of CMS fee schedule,12.05,75,,,fee schedule,75% of CMS fee schedule,16.07,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.09,40,,18.47,percent of total billed charges,40% of total billed charges,12.05,46.18,
URINE PH,7012032,CDM,300,RC,83986,HCPCS,Outpatient,,,17.08,13.66,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.66,80,,10.93,percent of total billed charges,80% of total billed charges,6.37,37.27,,5.1,percent of total billed charges,37.27% of total billed charges,6.37,37.27,,5.1,percent of total billed charges,37.27% of total billed charges,6.37,37.27,,5.1,percent of total billed charges,37.27% of total billed charges,2.69,75,,,fee schedule,75% of CMS fee schedule,2.69,75,,,fee schedule,75% of CMS fee schedule,3.58,100,,,fee schedule,100% of CMS fee schedule,3.58,100,,,fee schedule,100% of CMS fee schedule,2.69,75,,,fee schedule,75% of CMS fee schedule,2.69,75,,,fee schedule,75% of CMS fee schedule,3.58,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.83,40,,5.46,percent of total billed charges,40% of total billed charges,2.69,13.66,
AMIKACIN,7012032,CDM,300,RC,80150,HCPCS,Outpatient,,,55.58,44.46,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.46,80,,35.57,percent of total billed charges,80% of total billed charges,20.71,37.27,,16.57,percent of total billed charges,37.27% of total billed charges,20.71,37.27,,16.57,percent of total billed charges,37.27% of total billed charges,20.71,37.27,,16.57,percent of total billed charges,37.27% of total billed charges,11.31,75,,,fee schedule,75% of CMS fee schedule,11.31,75,,,fee schedule,75% of CMS fee schedule,15.08,100,,,fee schedule,100% of CMS fee schedule,15.08,100,,,fee schedule,100% of CMS fee schedule,11.31,75,,,fee schedule,75% of CMS fee schedule,11.31,75,,,fee schedule,75% of CMS fee schedule,15.08,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.23,40,,17.78,percent of total billed charges,40% of total billed charges,11.31,44.46,
ESTROGEN TOTAL,7000029,CDM,301,RC,82672,HCPCS,Outpatient,,,103.6,82.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.88,80,,66.3,percent of total billed charges,80% of total billed charges,38.61,37.27,,30.89,percent of total billed charges,37.27% of total billed charges,38.61,37.27,,30.89,percent of total billed charges,37.27% of total billed charges,38.61,37.27,,30.89,percent of total billed charges,37.27% of total billed charges,16.28,75,,,fee schedule,75% of CMS fee schedule,16.28,75,,,fee schedule,75% of CMS fee schedule,21.7,100,,,fee schedule,100% of CMS fee schedule,21.7,100,,,fee schedule,100% of CMS fee schedule,16.28,75,,,fee schedule,75% of CMS fee schedule,16.28,75,,,fee schedule,75% of CMS fee schedule,21.7,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.44,40,,33.15,percent of total billed charges,40% of total billed charges,16.28,82.88,
"HCG,QT (LAB CORP)",7000029,CDM,301,RC,84702,HCPCS,Outpatient,,,71.89,57.51,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.51,80,,46.01,percent of total billed charges,80% of total billed charges,26.79,37.27,,21.43,percent of total billed charges,37.27% of total billed charges,26.79,37.27,,21.43,percent of total billed charges,37.27% of total billed charges,26.79,37.27,,21.43,percent of total billed charges,37.27% of total billed charges,11.29,75,,,fee schedule,75% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,11.29,75,,,fee schedule,75% of CMS fee schedule,15.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.76,40,,23.01,percent of total billed charges,40% of total billed charges,11.29,57.51,
FRANCISELLA TUL ABS,7000169,CDM,302,RC,86668,HCPCS,Outpatient,,,49.67,39.74,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.74,80,,31.79,percent of total billed charges,80% of total billed charges,18.51,37.27,,14.81,percent of total billed charges,37.27% of total billed charges,18.51,37.27,,14.81,percent of total billed charges,37.27% of total billed charges,18.51,37.27,,14.81,percent of total billed charges,37.27% of total billed charges,10.62,75,,,fee schedule,75% of CMS fee schedule,10.62,75,,,fee schedule,75% of CMS fee schedule,14.16,100,,,fee schedule,100% of CMS fee schedule,14.16,100,,,fee schedule,100% of CMS fee schedule,10.62,75,,,fee schedule,75% of CMS fee schedule,10.62,75,,,fee schedule,75% of CMS fee schedule,14.16,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.87,40,,15.9,percent of total billed charges,40% of total billed charges,10.62,39.74,
URINE CHLORIDE RANDO,7000029,CDM,301,RC,82436,HCPCS,Outpatient,,,24,19.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,4.31,75,,,fee schedule,75% of CMS fee schedule,4.31,75,,,fee schedule,75% of CMS fee schedule,5.75,100,,,fee schedule,100% of CMS fee schedule,5.75,100,,,fee schedule,100% of CMS fee schedule,4.31,75,,,fee schedule,75% of CMS fee schedule,4.31,75,,,fee schedule,75% of CMS fee schedule,5.75,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,4.31,19.2,
PEDI THYROGLOBULIN,7000029,CDM,301,RC,86376,HCPCS,Outpatient,,,69.48,55.58,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.58,80,,44.46,percent of total billed charges,80% of total billed charges,25.9,37.27,,20.72,percent of total billed charges,37.27% of total billed charges,25.9,37.27,,20.72,percent of total billed charges,37.27% of total billed charges,25.9,37.27,,20.72,percent of total billed charges,37.27% of total billed charges,10.91,75,,,fee schedule,75% of CMS fee schedule,10.91,75,,,fee schedule,75% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,10.91,75,,,fee schedule,75% of CMS fee schedule,10.91,75,,,fee schedule,75% of CMS fee schedule,14.55,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.79,40,,22.23,percent of total billed charges,40% of total billed charges,10.91,55.58,
PEDI MICROSOMAL,7000029,CDM,301,RC,86800,HCPCS,Outpatient,,,75.95,60.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.76,80,,48.61,percent of total billed charges,80% of total billed charges,28.31,37.27,,22.65,percent of total billed charges,37.27% of total billed charges,28.31,37.27,,22.65,percent of total billed charges,37.27% of total billed charges,28.31,37.27,,22.65,percent of total billed charges,37.27% of total billed charges,11.93,75,,,fee schedule,75% of CMS fee schedule,11.93,75,,,fee schedule,75% of CMS fee schedule,15.91,100,,,fee schedule,100% of CMS fee schedule,15.91,100,,,fee schedule,100% of CMS fee schedule,11.93,75,,,fee schedule,75% of CMS fee schedule,11.93,75,,,fee schedule,75% of CMS fee schedule,15.91,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.38,40,,24.3,percent of total billed charges,40% of total billed charges,11.93,60.76,
PED HCG B SUBUNIT,7000029,CDM,301,RC,84703,HCPCS,Outpatient,,,36,28.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,5.64,75,,,fee schedule,75% of CMS fee schedule,5.64,75,,,fee schedule,75% of CMS fee schedule,7.52,100,,,fee schedule,100% of CMS fee schedule,7.52,100,,,fee schedule,100% of CMS fee schedule,5.64,75,,,fee schedule,75% of CMS fee schedule,5.64,75,,,fee schedule,75% of CMS fee schedule,7.52,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,5.64,28.8,
PED AFP,7000029,CDM,301,RC,82105,HCPCS,Outpatient,,,80.12,64.10,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.1,80,,51.28,percent of total billed charges,80% of total billed charges,29.86,37.27,,23.89,percent of total billed charges,37.27% of total billed charges,29.86,37.27,,23.89,percent of total billed charges,37.27% of total billed charges,29.86,37.27,,23.89,percent of total billed charges,37.27% of total billed charges,12.58,75,,,fee schedule,75% of CMS fee schedule,12.58,75,,,fee schedule,75% of CMS fee schedule,16.77,100,,,fee schedule,100% of CMS fee schedule,16.77,100,,,fee schedule,100% of CMS fee schedule,12.58,75,,,fee schedule,75% of CMS fee schedule,12.58,75,,,fee schedule,75% of CMS fee schedule,16.77,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.05,40,,25.64,percent of total billed charges,40% of total billed charges,12.58,64.1,
PED ALDOSTERONE,7000029,CDM,301,RC,82088,HCPCS,Outpatient,,,194.6,155.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.68,80,,124.54,percent of total billed charges,80% of total billed charges,72.53,37.27,,58.02,percent of total billed charges,37.27% of total billed charges,72.53,37.27,,58.02,percent of total billed charges,37.27% of total billed charges,72.53,37.27,,58.02,percent of total billed charges,37.27% of total billed charges,30.56,75,,,fee schedule,75% of CMS fee schedule,30.56,75,,,fee schedule,75% of CMS fee schedule,40.75,100,,,fee schedule,100% of CMS fee schedule,40.75,100,,,fee schedule,100% of CMS fee schedule,30.56,75,,,fee schedule,75% of CMS fee schedule,30.56,75,,,fee schedule,75% of CMS fee schedule,40.75,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.84,40,,62.27,percent of total billed charges,40% of total billed charges,30.56,155.68,
THYROTROPIN RECEP AB,7000029,CDM,301,RC,83520,HCPCS,Outpatient,,,61.81,49.45,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.45,80,,39.56,percent of total billed charges,80% of total billed charges,23.04,37.27,,18.43,percent of total billed charges,37.27% of total billed charges,23.04,37.27,,18.43,percent of total billed charges,37.27% of total billed charges,23.04,37.27,,18.43,percent of total billed charges,37.27% of total billed charges,12.95,75,,,fee schedule,75% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,12.95,75,,,fee schedule,75% of CMS fee schedule,17.27,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.72,40,,19.78,percent of total billed charges,40% of total billed charges,12.95,49.45,
COCCIDIODES IGM-IGG,7000169,CDM,302,RC,86635,HCPCS,Outpatient,,,55.2,44.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.16,80,,35.33,percent of total billed charges,80% of total billed charges,20.57,37.27,,16.46,percent of total billed charges,37.27% of total billed charges,20.57,37.27,,16.46,percent of total billed charges,37.27% of total billed charges,20.57,37.27,,16.46,percent of total billed charges,37.27% of total billed charges,8.6,75,,,fee schedule,75% of CMS fee schedule,8.6,75,,,fee schedule,75% of CMS fee schedule,11.47,100,,,fee schedule,100% of CMS fee schedule,11.47,100,,,fee schedule,100% of CMS fee schedule,8.6,75,,,fee schedule,75% of CMS fee schedule,8.6,75,,,fee schedule,75% of CMS fee schedule,11.47,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,40,,17.66,percent of total billed charges,40% of total billed charges,8.6,44.16,
BARTONELLA DNA PCR,7000169,CDM,302,RC,87471,HCPCS,Outpatient,,,167.55,134.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.04,80,,107.23,percent of total billed charges,80% of total billed charges,62.45,37.27,,49.96,percent of total billed charges,37.27% of total billed charges,62.45,37.27,,49.96,percent of total billed charges,37.27% of total billed charges,62.45,37.27,,49.96,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.02,40,,53.62,percent of total billed charges,40% of total billed charges,26.32,134.04,
HISTOPLASMA AG/SERUM,7000284,CDM,306,RC,87385,HCPCS,Outpatient,,,57.72,46.18,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.18,80,,36.94,percent of total billed charges,80% of total billed charges,21.51,37.27,,17.21,percent of total billed charges,37.27% of total billed charges,21.51,37.27,,17.21,percent of total billed charges,37.27% of total billed charges,21.51,37.27,,17.21,percent of total billed charges,37.27% of total billed charges,9.94,75,,,fee schedule,75% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,9.94,75,,,fee schedule,75% of CMS fee schedule,13.25,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.09,40,,18.47,percent of total billed charges,40% of total billed charges,9.94,46.18,
RAST LATEX,7000169,CDM,302,RC,86008,HCPCS,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,9.32,20,
SMITH AB,7000169,CDM,302,RC,86235,HCPCS,Outpatient,,,31,24.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,11.55,24.8,
NATURAL KILLER CELLS,7000169,CDM,302,RC,86357,HCPCS,Outpatient,,,180,144.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,80,,115.2,percent of total billed charges,80% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% of total billed charges,28.3,75,,,fee schedule,75% of CMS fee schedule,28.3,75,,,fee schedule,75% of CMS fee schedule,37.73,100,,,fee schedule,100% of CMS fee schedule,37.73,100,,,fee schedule,100% of CMS fee schedule,28.3,75,,,fee schedule,75% of CMS fee schedule,28.3,75,,,fee schedule,75% of CMS fee schedule,37.73,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,40,,57.6,percent of total billed charges,40% of total billed charges,28.3,144,
RUBEOLA IGM,7000169,CDM,302,RC,86765,HCPCS,Outpatient,,,61.36,49.09,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.09,80,,39.27,percent of total billed charges,80% of total billed charges,22.87,37.27,,18.3,percent of total billed charges,37.27% of total billed charges,22.87,37.27,,18.3,percent of total billed charges,37.27% of total billed charges,22.87,37.27,,18.3,percent of total billed charges,37.27% of total billed charges,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.54,40,,19.63,percent of total billed charges,40% of total billed charges,9.66,49.09,
ANTICHROMATIN ANTIBO,7000169,CDM,302,RC,86235,HCPCS,Outpatient,,,55.44,44.35,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.35,80,,35.48,percent of total billed charges,80% of total billed charges,20.66,37.27,,16.53,percent of total billed charges,37.27% of total billed charges,20.66,37.27,,16.53,percent of total billed charges,37.27% of total billed charges,20.66,37.27,,16.53,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.18,40,,17.74,percent of total billed charges,40% of total billed charges,13.45,44.35,
ANTI-RIBOSOMAL P,7012032,CDM,300,RC,83516,HCPCS,Outpatient,,,55,44.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22,40,,17.6,percent of total billed charges,40% of total billed charges,8.65,44,
CYTOPATH C/V AUTO FL,7039034,CDM,311,RC,88175,HCPCS,Outpatient,,,88,70.40,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,19.96,75,,,fee schedule,75% of CMS fee schedule,19.96,75,,,fee schedule,75% of CMS fee schedule,26.61,100,,,fee schedule,100% of CMS fee schedule,26.61,100,,,fee schedule,100% of CMS fee schedule,19.96,75,,,fee schedule,75% of CMS fee schedule,19.96,75,,,fee schedule,75% of CMS fee schedule,26.61,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,40,,28.16,percent of total billed charges,40% of total billed charges,19.96,70.4,
TREPONEMA PALLIDUM,7000169,CDM,302,RC,86780,HCPCS,Outpatient,,,63,50.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,9.93,75,,,fee schedule,75% of CMS fee schedule,9.93,75,,,fee schedule,75% of CMS fee schedule,13.24,100,,,fee schedule,100% of CMS fee schedule,13.24,100,,,fee schedule,100% of CMS fee schedule,9.93,75,,,fee schedule,75% of CMS fee schedule,9.93,75,,,fee schedule,75% of CMS fee schedule,13.24,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,40,,20.16,percent of total billed charges,40% of total billed charges,9.93,50.4,
PTHR PEPTIDE,7012032,CDM,300,RC,82397,HCPCS,Outpatient,,,22.09,17.67,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.67,80,,14.14,percent of total billed charges,80% of total billed charges,8.23,37.27,,6.58,percent of total billed charges,37.27% of total billed charges,8.23,37.27,,6.58,percent of total billed charges,37.27% of total billed charges,8.23,37.27,,6.58,percent of total billed charges,37.27% of total billed charges,10.59,75,,,fee schedule,75% of CMS fee schedule,10.59,75,,,fee schedule,75% of CMS fee schedule,14.12,100,,,fee schedule,100% of CMS fee schedule,14.12,100,,,fee schedule,100% of CMS fee schedule,10.59,75,,,fee schedule,75% of CMS fee schedule,10.59,75,,,fee schedule,75% of CMS fee schedule,14.12,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.84,40,,7.07,percent of total billed charges,40% of total billed charges,8.23,17.67,
HIGH SENSITIVITY CRP,7000169,CDM,302,RC,86141,HCPCS,Outpatient,,,62,49.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,9.71,75,,,fee schedule,75% of CMS fee schedule,9.71,75,,,fee schedule,75% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,9.71,75,,,fee schedule,75% of CMS fee schedule,9.71,75,,,fee schedule,75% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,40,,19.84,percent of total billed charges,40% of total billed charges,9.71,49.6,
HEMATOCRIT,7000177,CDM,305,RC,85014,HCPCS,Outpatient,,,11.31,9.05,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.05,80,,7.24,percent of total billed charges,80% of total billed charges,4.22,37.27,,3.38,percent of total billed charges,37.27% of total billed charges,4.22,37.27,,3.38,percent of total billed charges,37.27% of total billed charges,4.22,37.27,,3.38,percent of total billed charges,37.27% of total billed charges,1.78,75,,,fee schedule,75% of CMS fee schedule,1.78,75,,,fee schedule,75% of CMS fee schedule,2.37,100,,,fee schedule,100% of CMS fee schedule,2.37,100,,,fee schedule,100% of CMS fee schedule,1.78,75,,,fee schedule,75% of CMS fee schedule,1.78,75,,,fee schedule,75% of CMS fee schedule,2.37,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.52,40,,3.62,percent of total billed charges,40% of total billed charges,1.78,9.05,
PED ACTH,7012032,CDM,300,RC,82024,HCPCS,Outpatient,,,184,147.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.2,80,,117.76,percent of total billed charges,80% of total billed charges,68.58,37.27,,54.86,percent of total billed charges,37.27% of total billed charges,68.58,37.27,,54.86,percent of total billed charges,37.27% of total billed charges,68.58,37.27,,54.86,percent of total billed charges,37.27% of total billed charges,28.97,75,,,fee schedule,75% of CMS fee schedule,28.97,75,,,fee schedule,75% of CMS fee schedule,38.62,100,,,fee schedule,100% of CMS fee schedule,38.62,100,,,fee schedule,100% of CMS fee schedule,28.97,75,,,fee schedule,75% of CMS fee schedule,28.97,75,,,fee schedule,75% of CMS fee schedule,38.62,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,40,,58.88,percent of total billed charges,40% of total billed charges,28.97,147.2,
GLUCOSE QUANT BLOOD,7000029,CDM,301,RC,82962,HCPCS,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,40,,4.8,percent of total billed charges,40% of total billed charges,2.46,12,
BCR/ABL1,7000029,CDM,301,RC,81206,HCPCS,Outpatient,,,783,626.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,626.4,80,,501.12,percent of total billed charges,80% of total billed charges,291.82,37.27,,233.46,percent of total billed charges,37.27% of total billed charges,291.82,37.27,,233.46,percent of total billed charges,37.27% of total billed charges,291.82,37.27,,233.46,percent of total billed charges,37.27% of total billed charges,122.97,75,,,fee schedule,75% of CMS fee schedule,122.97,75,,,fee schedule,75% of CMS fee schedule,163.96,100,,,fee schedule,100% of CMS fee schedule,163.96,100,,,fee schedule,100% of CMS fee schedule,122.97,75,,,fee schedule,75% of CMS fee schedule,122.97,75,,,fee schedule,75% of CMS fee schedule,163.96,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,313.2,40,,250.56,percent of total billed charges,40% of total billed charges,122.97,626.4,
SPEC STAIN OVA-PARAS,7000284,CDM,306,RC,87209,HCPCS,Outpatient,,,86,68.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,32.05,37.27,,25.64,percent of total billed charges,37.27% of total billed charges,32.05,37.27,,25.64,percent of total billed charges,37.27% of total billed charges,32.05,37.27,,25.64,percent of total billed charges,37.27% of total billed charges,13.49,75,,,fee schedule,75% of CMS fee schedule,13.49,75,,,fee schedule,75% of CMS fee schedule,17.98,100,,,fee schedule,100% of CMS fee schedule,17.98,100,,,fee schedule,100% of CMS fee schedule,13.49,75,,,fee schedule,75% of CMS fee schedule,13.49,75,,,fee schedule,75% of CMS fee schedule,17.98,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.4,40,,27.52,percent of total billed charges,40% of total billed charges,13.49,68.8,
FLECAINIDE,7000029,CDM,301,RC,82542,HCPCS,Outpatient,,,138,110.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.4,80,,88.32,percent of total billed charges,80% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% of total billed charges,18.07,75,,,fee schedule,75% of CMS fee schedule,18.07,75,,,fee schedule,75% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,18.07,75,,,fee schedule,75% of CMS fee schedule,18.07,75,,,fee schedule,75% of CMS fee schedule,24.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.2,40,,44.16,percent of total billed charges,40% of total billed charges,18.07,110.4,
VENIPUNCTURE NURS HO,7012032,CDM,300,RC,G0471,HCPCS,Outpatient,,,25,20.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,8.12,75,,,fee schedule,75% of CMS fee schedule,8.12,75,,,fee schedule,75% of CMS fee schedule,10.83,100,,,fee schedule,100% of CMS fee schedule,10.83,100,,,fee schedule,100% of CMS fee schedule,8.12,75,,,fee schedule,75% of CMS fee schedule,8.12,75,,,fee schedule,75% of CMS fee schedule,10.83,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,8.12,20,
SUBST PLASMA FRACTIO,7000177,CDM,305,RC,85611,HCPCS,Outpatient,,,18.5,14.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.8,80,,11.84,percent of total billed charges,80% of total billed charges,6.89,37.27,,5.51,percent of total billed charges,37.27% of total billed charges,6.89,37.27,,5.51,percent of total billed charges,37.27% of total billed charges,6.89,37.27,,5.51,percent of total billed charges,37.27% of total billed charges,2.96,75,,,fee schedule,75% of CMS fee schedule,2.96,75,,,fee schedule,75% of CMS fee schedule,3.94,100,,,fee schedule,100% of CMS fee schedule,3.94,100,,,fee schedule,100% of CMS fee schedule,2.96,75,,,fee schedule,75% of CMS fee schedule,2.96,75,,,fee schedule,75% of CMS fee schedule,3.94,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.4,40,,5.92,percent of total billed charges,40% of total billed charges,2.96,14.8,
SUBST PLASMA FRACTIO,7000177,CDM,305,RC,85732,HCPCS,Outpatient,,,31,24.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,4.85,75,,,fee schedule,75% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,4.85,24.8,
APOLIPOPROTEIN A1&B,7000029,CDM,301,RC,82172,HCPCS,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,15.82,75,,,fee schedule,75% of CMS fee schedule,15.82,75,,,fee schedule,75% of CMS fee schedule,21.09,100,,,fee schedule,100% of CMS fee schedule,21.09,100,,,fee schedule,100% of CMS fee schedule,15.82,75,,,fee schedule,75% of CMS fee schedule,15.82,75,,,fee schedule,75% of CMS fee schedule,21.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,15.82,59.2,
IMMUN TUMOR ANTIGEN,7000169,CDM,302,RC,86316,HCPCS,Outpatient,,,99,79.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,15.61,75,,,fee schedule,75% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,15.61,75,,,fee schedule,75% of CMS fee schedule,20.81,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,15.61,79.2,
EVAL CERVICOVAG FLUI,7000029,CDM,301,RC,84112,HCPCS,Outpatient,,,307,245.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,114.42,37.27,,91.54,percent of total billed charges,37.27% of total billed charges,114.42,37.27,,91.54,percent of total billed charges,37.27% of total billed charges,114.42,37.27,,91.54,percent of total billed charges,37.27% of total billed charges,73.58,75,,,fee schedule,75% of CMS fee schedule,73.58,75,,,fee schedule,75% of CMS fee schedule,98.11,100,,,fee schedule,100% of CMS fee schedule,98.11,100,,,fee schedule,100% of CMS fee schedule,73.58,75,,,fee schedule,75% of CMS fee schedule,73.58,75,,,fee schedule,75% of CMS fee schedule,98.11,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.8,40,,98.24,percent of total billed charges,40% of total billed charges,73.58,245.6,
STREP PNEUMO AG URIN,7000284,CDM,306,RC,87899,HCPCS,Outpatient,,,57,45.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,12.05,75,,,fee schedule,75% of CMS fee schedule,12.05,75,,,fee schedule,75% of CMS fee schedule,16.07,100,,,fee schedule,100% of CMS fee schedule,16.07,100,,,fee schedule,100% of CMS fee schedule,12.05,75,,,fee schedule,75% of CMS fee schedule,12.05,75,,,fee schedule,75% of CMS fee schedule,16.07,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,40,,18.24,percent of total billed charges,40% of total billed charges,12.05,45.6,
PARASITE ID WORM,7000284,CDM,306,RC,87169,HCPCS,Outpatient,,,20.34,16.27,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.27,80,,13.02,percent of total billed charges,80% of total billed charges,7.58,37.27,,6.06,percent of total billed charges,37.27% of total billed charges,7.58,37.27,,6.06,percent of total billed charges,37.27% of total billed charges,7.58,37.27,,6.06,percent of total billed charges,37.27% of total billed charges,3.23,75,,,fee schedule,75% of CMS fee schedule,3.23,75,,,fee schedule,75% of CMS fee schedule,4.31,100,,,fee schedule,100% of CMS fee schedule,4.31,100,,,fee schedule,100% of CMS fee schedule,3.23,75,,,fee schedule,75% of CMS fee schedule,3.23,75,,,fee schedule,75% of CMS fee schedule,4.31,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.14,40,,6.51,percent of total billed charges,40% of total billed charges,3.23,16.27,
"VITAMIN C,ASCORBIC A",7000029,CDM,301,RC,82180,HCPCS,Outpatient,,,40.36,32.29,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.29,80,,25.83,percent of total billed charges,80% of total billed charges,15.04,37.27,,12.03,percent of total billed charges,37.27% of total billed charges,15.04,37.27,,12.03,percent of total billed charges,37.27% of total billed charges,15.04,37.27,,12.03,percent of total billed charges,37.27% of total billed charges,7.42,75,,,fee schedule,75% of CMS fee schedule,7.42,75,,,fee schedule,75% of CMS fee schedule,9.89,100,,,fee schedule,100% of CMS fee schedule,9.89,100,,,fee schedule,100% of CMS fee schedule,7.42,75,,,fee schedule,75% of CMS fee schedule,7.42,75,,,fee schedule,75% of CMS fee schedule,9.89,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.14,40,,12.91,percent of total billed charges,40% of total billed charges,7.42,32.29,
MUMPS IGM ACUTE INFE,7000169,CDM,302,RC,86735,HCPCS,Outpatient,,,62,49.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,9.79,75,,,fee schedule,75% of CMS fee schedule,9.79,75,,,fee schedule,75% of CMS fee schedule,13.05,100,,,fee schedule,100% of CMS fee schedule,13.05,100,,,fee schedule,100% of CMS fee schedule,9.79,75,,,fee schedule,75% of CMS fee schedule,9.79,75,,,fee schedule,75% of CMS fee schedule,13.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,40,,19.84,percent of total billed charges,40% of total billed charges,9.79,49.6,
MUMPS IGG IMMUNITY,7000169,CDM,302,RC,86735,HCPCS,Outpatient,,,62,49.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,9.79,75,,,fee schedule,75% of CMS fee schedule,9.79,75,,,fee schedule,75% of CMS fee schedule,13.05,100,,,fee schedule,100% of CMS fee schedule,13.05,100,,,fee schedule,100% of CMS fee schedule,9.79,75,,,fee schedule,75% of CMS fee schedule,9.79,75,,,fee schedule,75% of CMS fee schedule,13.05,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,40,,19.84,percent of total billed charges,40% of total billed charges,9.79,49.6,
"CBC, AUTOMATED",7000177,CDM,305,RC,85027,HCPCS,Outpatient,,,30.84,24.67,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.67,80,,19.74,percent of total billed charges,80% of total billed charges,11.49,37.27,,9.19,percent of total billed charges,37.27% of total billed charges,11.49,37.27,,9.19,percent of total billed charges,37.27% of total billed charges,11.49,37.27,,9.19,percent of total billed charges,37.27% of total billed charges,4.85,75,,,fee schedule,75% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,4.85,75,,,fee schedule,75% of CMS fee schedule,6.47,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.34,40,,9.87,percent of total billed charges,40% of total billed charges,4.85,24.67,
MAN DIFF (ONLY),7000177,CDM,305,RC,85007,HCPCS,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,2.85,75,,,fee schedule,75% of CMS fee schedule,2.85,75,,,fee schedule,75% of CMS fee schedule,3.8,100,,,fee schedule,100% of CMS fee schedule,3.8,100,,,fee schedule,100% of CMS fee schedule,2.85,75,,,fee schedule,75% of CMS fee schedule,2.85,75,,,fee schedule,75% of CMS fee schedule,3.8,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,2.85,9.6,
COUNT 15-20 CELLS 2,7039034,CDM,311,RC,88262,HCPCS,Outpatient,,,593.7,474.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,474.96,80,,379.97,percent of total billed charges,80% of total billed charges,221.27,37.27,,177.02,percent of total billed charges,37.27% of total billed charges,221.27,37.27,,177.02,percent of total billed charges,37.27% of total billed charges,221.27,37.27,,177.02,percent of total billed charges,37.27% of total billed charges,94.12,75,,,fee schedule,75% of CMS fee schedule,94.12,75,,,fee schedule,75% of CMS fee schedule,125.49,100,,,fee schedule,100% of CMS fee schedule,125.49,100,,,fee schedule,100% of CMS fee schedule,94.12,75,,,fee schedule,75% of CMS fee schedule,94.12,75,,,fee schedule,75% of CMS fee schedule,125.49,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,237.48,40,,189.98,percent of total billed charges,40% of total billed charges,94.12,474.96,
BRUCELLA,7000029,CDM,301,RC,86622,HCPCS,Outpatient,,,43.72,34.98,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.98,80,,27.98,percent of total billed charges,80% of total billed charges,16.29,37.27,,13.03,percent of total billed charges,37.27% of total billed charges,16.29,37.27,,13.03,percent of total billed charges,37.27% of total billed charges,16.29,37.27,,13.03,percent of total billed charges,37.27% of total billed charges,6.7,75,,,fee schedule,75% of CMS fee schedule,6.7,75,,,fee schedule,75% of CMS fee schedule,8.93,100,,,fee schedule,100% of CMS fee schedule,8.93,100,,,fee schedule,100% of CMS fee schedule,6.7,75,,,fee schedule,75% of CMS fee schedule,6.7,75,,,fee schedule,75% of CMS fee schedule,8.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.49,40,,13.99,percent of total billed charges,40% of total billed charges,6.7,34.98,
CRYPTOSPORIDIUM STOO,7000284,CDM,306,RC,87328,HCPCS,Outpatient,,,57,45.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,10.37,75,,,fee schedule,75% of CMS fee schedule,10.37,75,,,fee schedule,75% of CMS fee schedule,13.82,100,,,fee schedule,100% of CMS fee schedule,13.82,100,,,fee schedule,100% of CMS fee schedule,10.37,75,,,fee schedule,75% of CMS fee schedule,10.37,75,,,fee schedule,75% of CMS fee schedule,13.82,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,40,,18.24,percent of total billed charges,40% of total billed charges,10.37,45.6,
NEUTRALIZATION TEST,7000169,CDM,302,RC,86382,HCPCS,Outpatient,,,81,64.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,12.68,75,,,fee schedule,75% of CMS fee schedule,12.68,75,,,fee schedule,75% of CMS fee schedule,16.91,100,,,fee schedule,100% of CMS fee schedule,16.91,100,,,fee schedule,100% of CMS fee schedule,12.68,75,,,fee schedule,75% of CMS fee schedule,12.68,75,,,fee schedule,75% of CMS fee schedule,16.91,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,40,,25.92,percent of total billed charges,40% of total billed charges,12.68,64.8,
HIV 1 ANTIGEN W/HIV1,7000284,CDM,306,RC,87389,HCPCS,Outpatient,,,107.1,85.68,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.68,80,,68.54,percent of total billed charges,80% of total billed charges,39.92,37.27,,31.94,percent of total billed charges,37.27% of total billed charges,39.92,37.27,,31.94,percent of total billed charges,37.27% of total billed charges,39.92,37.27,,31.94,percent of total billed charges,37.27% of total billed charges,18.06,75,,,fee schedule,75% of CMS fee schedule,18.06,75,,,fee schedule,75% of CMS fee schedule,24.08,100,,,fee schedule,100% of CMS fee schedule,24.08,100,,,fee schedule,100% of CMS fee schedule,18.06,75,,,fee schedule,75% of CMS fee schedule,18.06,75,,,fee schedule,75% of CMS fee schedule,24.08,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.84,40,,34.27,percent of total billed charges,40% of total billed charges,18.06,85.68,
SPUN MICROHEMATOCRIT,7000177,CDM,305,RC,85013,HCPCS,Outpatient,,,11.31,9.05,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.05,80,,7.24,percent of total billed charges,80% of total billed charges,4.22,37.27,,3.38,percent of total billed charges,37.27% of total billed charges,4.22,37.27,,3.38,percent of total billed charges,37.27% of total billed charges,4.22,37.27,,3.38,percent of total billed charges,37.27% of total billed charges,5.25,75,,,fee schedule,75% of CMS fee schedule,5.25,75,,,fee schedule,75% of CMS fee schedule,7,100,,,fee schedule,100% of CMS fee schedule,7,100,,,fee schedule,100% of CMS fee schedule,5.25,75,,,fee schedule,75% of CMS fee schedule,5.25,75,,,fee schedule,75% of CMS fee schedule,7,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.52,40,,3.62,percent of total billed charges,40% of total billed charges,4.22,9.05,
CARBOXYHEMOGLOBIN QN,7000029,CDM,301,RC,82375,HCPCS,Outpatient,,,59,47.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,9.24,75,,,fee schedule,75% of CMS fee schedule,9.24,75,,,fee schedule,75% of CMS fee schedule,12.32,100,,,fee schedule,100% of CMS fee schedule,12.32,100,,,fee schedule,100% of CMS fee schedule,9.24,75,,,fee schedule,75% of CMS fee schedule,9.24,75,,,fee schedule,75% of CMS fee schedule,12.32,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.6,40,,18.88,percent of total billed charges,40% of total billed charges,9.24,47.2,
CCP CYCLIC CITRULLIN,7000169,CDM,302,RC,86200,HCPCS,Outpatient,,,62,49.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,9.71,75,,,fee schedule,75% of CMS fee schedule,9.71,75,,,fee schedule,75% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,9.71,75,,,fee schedule,75% of CMS fee schedule,9.71,75,,,fee schedule,75% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,40,,19.84,percent of total billed charges,40% of total billed charges,9.71,49.6,
ANAEROBIC ISOLATE,7000284,CDM,306,RC,87076,HCPCS,Outpatient,,,38.5,30.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,80,,24.64,percent of total billed charges,80% of total billed charges,14.35,37.27,,11.48,percent of total billed charges,37.27% of total billed charges,14.35,37.27,,11.48,percent of total billed charges,37.27% of total billed charges,14.35,37.27,,11.48,percent of total billed charges,37.27% of total billed charges,6.06,75,,,fee schedule,75% of CMS fee schedule,6.06,75,,,fee schedule,75% of CMS fee schedule,8.08,100,,,fee schedule,100% of CMS fee schedule,8.08,100,,,fee schedule,100% of CMS fee schedule,6.06,75,,,fee schedule,75% of CMS fee schedule,6.06,75,,,fee schedule,75% of CMS fee schedule,8.08,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.4,40,,12.32,percent of total billed charges,40% of total billed charges,6.06,30.8,
FIBRINOGEN ACTIVITY,7000177,CDM,305,RC,85384,HCPCS,Outpatient,,,40,32.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,7.29,75,,,fee schedule,75% of CMS fee schedule,7.29,75,,,fee schedule,75% of CMS fee schedule,9.72,100,,,fee schedule,100% of CMS fee schedule,9.72,100,,,fee schedule,100% of CMS fee schedule,7.29,75,,,fee schedule,75% of CMS fee schedule,7.29,75,,,fee schedule,75% of CMS fee schedule,9.72,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,40,,12.8,percent of total billed charges,40% of total billed charges,7.29,32,
GLYCATED PROTEIN,7000029,CDM,301,RC,82985,HCPCS,Outpatient,,,72,57.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,80,,46.08,percent of total billed charges,80% of total billed charges,26.83,37.27,,21.46,percent of total billed charges,37.27% of total billed charges,26.83,37.27,,21.46,percent of total billed charges,37.27% of total billed charges,26.83,37.27,,21.46,percent of total billed charges,37.27% of total billed charges,12.57,75,,,fee schedule,75% of CMS fee schedule,12.57,75,,,fee schedule,75% of CMS fee schedule,16.76,100,,,fee schedule,100% of CMS fee schedule,16.76,100,,,fee schedule,100% of CMS fee schedule,12.57,75,,,fee schedule,75% of CMS fee schedule,12.57,75,,,fee schedule,75% of CMS fee schedule,16.76,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,40,,23.04,percent of total billed charges,40% of total billed charges,12.57,57.6,
AFP-L3,7000029,CDM,301,RC,82107,HCPCS,Outpatient,,,307,245.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.6,80,,196.48,percent of total billed charges,80% of total billed charges,114.42,37.27,,91.54,percent of total billed charges,37.27% of total billed charges,114.42,37.27,,91.54,percent of total billed charges,37.27% of total billed charges,114.42,37.27,,91.54,percent of total billed charges,37.27% of total billed charges,48.31,75,,,fee schedule,75% of CMS fee schedule,48.31,75,,,fee schedule,75% of CMS fee schedule,64.41,100,,,fee schedule,100% of CMS fee schedule,64.41,100,,,fee schedule,100% of CMS fee schedule,48.31,75,,,fee schedule,75% of CMS fee schedule,48.31,75,,,fee schedule,75% of CMS fee schedule,64.41,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.8,40,,98.24,percent of total billed charges,40% of total billed charges,48.31,245.6,
GLUCOSE 6-PHOS DEHYD,7000029,CDM,301,RC,82955,HCPCS,Outpatient,,,46,36.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,7.28,75,,,fee schedule,75% of CMS fee schedule,7.28,75,,,fee schedule,75% of CMS fee schedule,9.7,100,,,fee schedule,100% of CMS fee schedule,9.7,100,,,fee schedule,100% of CMS fee schedule,7.28,75,,,fee schedule,75% of CMS fee schedule,7.28,75,,,fee schedule,75% of CMS fee schedule,9.7,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,7.28,36.8,
CADMIUM BLOOD,7000029,CDM,301,RC,82300,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,17.73,75,,,fee schedule,75% of CMS fee schedule,17.73,75,,,fee schedule,75% of CMS fee schedule,23.64,100,,,fee schedule,100% of CMS fee schedule,23.64,100,,,fee schedule,100% of CMS fee schedule,17.73,75,,,fee schedule,75% of CMS fee schedule,17.73,75,,,fee schedule,75% of CMS fee schedule,23.64,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,40,,35.2,percent of total billed charges,40% of total billed charges,17.73,88,
MOLD ID,7000284,CDM,306,RC,87107,HCPCS,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,7.74,75,,,fee schedule,75% of CMS fee schedule,7.74,75,,,fee schedule,75% of CMS fee schedule,10.32,100,,,fee schedule,100% of CMS fee schedule,10.32,100,,,fee schedule,100% of CMS fee schedule,7.74,75,,,fee schedule,75% of CMS fee schedule,7.74,75,,,fee schedule,75% of CMS fee schedule,10.32,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,7.74,39.2,
ETHYLENE GLYCOL,7000029,CDM,301,RC,82693,HCPCS,Outpatient,,,71,56.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,11.18,75,,,fee schedule,75% of CMS fee schedule,11.18,75,,,fee schedule,75% of CMS fee schedule,14.9,100,,,fee schedule,100% of CMS fee schedule,14.9,100,,,fee schedule,100% of CMS fee schedule,11.18,75,,,fee schedule,75% of CMS fee schedule,11.18,75,,,fee schedule,75% of CMS fee schedule,14.9,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.4,40,,22.72,percent of total billed charges,40% of total billed charges,11.18,56.8,
OB PANEL W/HIV,7000029,CDM,301,RC,80081,HCPCS,Outpatient,,,356.9,285.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,285.52,80,,228.42,percent of total billed charges,80% of total billed charges,133.02,37.27,,106.42,percent of total billed charges,37.27% of total billed charges,133.02,37.27,,106.42,percent of total billed charges,37.27% of total billed charges,133.02,37.27,,106.42,percent of total billed charges,37.27% of total billed charges,56.15,75,,,fee schedule,75% of CMS fee schedule,56.15,75,,,fee schedule,75% of CMS fee schedule,74.86,100,,,fee schedule,100% of CMS fee schedule,74.86,100,,,fee schedule,100% of CMS fee schedule,56.15,75,,,fee schedule,75% of CMS fee schedule,56.15,75,,,fee schedule,75% of CMS fee schedule,74.86,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.76,40,,114.21,percent of total billed charges,40% of total billed charges,56.15,285.52,
QT OF THER DRUG,7000029,CDM,301,RC,80299,HCPCS,Outpatient,,,65.3,52.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.24,80,,41.79,percent of total billed charges,80% of total billed charges,24.34,37.27,,19.47,percent of total billed charges,37.27% of total billed charges,24.34,37.27,,19.47,percent of total billed charges,37.27% of total billed charges,24.34,37.27,,19.47,percent of total billed charges,37.27% of total billed charges,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.12,40,,20.9,percent of total billed charges,40% of total billed charges,13.98,52.24,
"VALPROIC ACID, FREE",7000029,CDM,301,RC,80165,HCPCS,Outpatient,,,64.6,51.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.68,80,,41.34,percent of total billed charges,80% of total billed charges,24.08,37.27,,19.26,percent of total billed charges,37.27% of total billed charges,24.08,37.27,,19.26,percent of total billed charges,37.27% of total billed charges,24.08,37.27,,19.26,percent of total billed charges,37.27% of total billed charges,10.16,75,,,fee schedule,75% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,10.16,75,,,fee schedule,75% of CMS fee schedule,13.54,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.84,40,,20.67,percent of total billed charges,40% of total billed charges,10.16,51.68,
AMIODARONE QUANITATI,7000029,CDM,301,RC,80151,HCPCS,Outpatient,,,65.31,52.25,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.25,80,,41.8,percent of total billed charges,80% of total billed charges,24.34,37.27,,19.47,percent of total billed charges,37.27% of total billed charges,24.34,37.27,,19.47,percent of total billed charges,37.27% of total billed charges,24.34,37.27,,19.47,percent of total billed charges,37.27% of total billed charges,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,13.98,75,,,fee schedule,75% of CMS fee schedule,18.64,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.12,40,,20.9,percent of total billed charges,40% of total billed charges,13.98,52.25,
HLA II TYPING 1 ALLE,7000268,CDM,310,RC,81383,HCPCS,Outpatient,,,520.31,416.25,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,416.25,80,,333,percent of total billed charges,80% of total billed charges,193.92,37.27,,155.14,percent of total billed charges,37.27% of total billed charges,193.92,37.27,,155.14,percent of total billed charges,37.27% of total billed charges,193.92,37.27,,155.14,percent of total billed charges,37.27% of total billed charges,81.85,75,,,fee schedule,75% of CMS fee schedule,81.85,75,,,fee schedule,75% of CMS fee schedule,109.13,100,,,fee schedule,100% of CMS fee schedule,109.13,100,,,fee schedule,100% of CMS fee schedule,81.85,75,,,fee schedule,75% of CMS fee schedule,81.85,75,,,fee schedule,75% of CMS fee schedule,109.13,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208.12,40,,166.5,percent of total billed charges,40% of total billed charges,81.85,416.25,
HLA II TYPE 1 AG EQU,7000268,CDM,310,RC,81377,HCPCS,Outpatient,,,437.71,350.17,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.17,80,,280.14,percent of total billed charges,80% of total billed charges,163.13,37.27,,130.5,percent of total billed charges,37.27% of total billed charges,163.13,37.27,,130.5,percent of total billed charges,37.27% of total billed charges,163.13,37.27,,130.5,percent of total billed charges,37.27% of total billed charges,71.06,75,,,fee schedule,75% of CMS fee schedule,71.06,75,,,fee schedule,75% of CMS fee schedule,94.74,100,,,fee schedule,100% of CMS fee schedule,94.74,100,,,fee schedule,100% of CMS fee schedule,71.06,75,,,fee schedule,75% of CMS fee schedule,71.06,75,,,fee schedule,75% of CMS fee schedule,94.74,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.08,40,,140.06,percent of total billed charges,40% of total billed charges,71.06,350.17,
HLA I TYPING 1 ANTIG,7000268,CDM,310,RC,81374,HCPCS,Outpatient,,,346.85,277.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.48,80,,221.98,percent of total billed charges,80% of total billed charges,129.27,37.27,,103.42,percent of total billed charges,37.27% of total billed charges,129.27,37.27,,103.42,percent of total billed charges,37.27% of total billed charges,129.27,37.27,,103.42,percent of total billed charges,37.27% of total billed charges,55.75,75,,,fee schedule,75% of CMS fee schedule,55.75,75,,,fee schedule,75% of CMS fee schedule,74.33,100,,,fee schedule,100% of CMS fee schedule,74.33,100,,,fee schedule,100% of CMS fee schedule,55.75,75,,,fee schedule,75% of CMS fee schedule,55.75,75,,,fee schedule,75% of CMS fee schedule,74.33,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.74,40,,110.99,percent of total billed charges,40% of total billed charges,55.75,277.48,
VITAMIN NOT OTH SPEC,7000029,CDM,301,RC,84591,HCPCS,Outpatient,,,55.34,44.27,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.27,80,,35.42,percent of total billed charges,80% of total billed charges,20.63,37.27,,16.5,percent of total billed charges,37.27% of total billed charges,20.63,37.27,,16.5,percent of total billed charges,37.27% of total billed charges,20.63,37.27,,16.5,percent of total billed charges,37.27% of total billed charges,12.8,75,,,fee schedule,75% of CMS fee schedule,12.8,75,,,fee schedule,75% of CMS fee schedule,17.06,100,,,fee schedule,100% of CMS fee schedule,17.06,100,,,fee schedule,100% of CMS fee schedule,12.8,75,,,fee schedule,75% of CMS fee schedule,12.8,75,,,fee schedule,75% of CMS fee schedule,17.06,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.14,40,,17.71,percent of total billed charges,40% of total billed charges,12.8,44.27,
HALOPERIDOL,7000029,CDM,301,RC,80173,HCPCS,Outpatient,,,55.51,44.41,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.41,80,,35.53,percent of total billed charges,80% of total billed charges,20.69,37.27,,16.55,percent of total billed charges,37.27% of total billed charges,20.69,37.27,,16.55,percent of total billed charges,37.27% of total billed charges,20.69,37.27,,16.55,percent of total billed charges,37.27% of total billed charges,11.84,75,,,fee schedule,75% of CMS fee schedule,11.84,75,,,fee schedule,75% of CMS fee schedule,15.78,100,,,fee schedule,100% of CMS fee schedule,15.78,100,,,fee schedule,100% of CMS fee schedule,11.84,75,,,fee schedule,75% of CMS fee schedule,11.84,75,,,fee schedule,75% of CMS fee schedule,15.78,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.2,40,,17.76,percent of total billed charges,40% of total billed charges,11.84,44.41,
ALLERGEN SPEC IGE RE,7000169,CDM,302,RC,86008,HCPCS,Outpatient,,,24.89,19.91,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.91,80,,15.93,percent of total billed charges,80% of total billed charges,9.28,37.27,,7.42,percent of total billed charges,37.27% of total billed charges,9.28,37.27,,7.42,percent of total billed charges,37.27% of total billed charges,9.28,37.27,,7.42,percent of total billed charges,37.27% of total billed charges,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,13.45,75,,,fee schedule,75% of CMS fee schedule,17.93,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.96,40,,7.97,percent of total billed charges,40% of total billed charges,9.28,19.91,
HEPATITIS B VIRUS,7000284,CDM,306,RC,87912,HCPCS,Outpatient,,,1236.03,988.82,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,988.82,80,,791.06,percent of total billed charges,80% of total billed charges,460.67,37.27,,368.54,percent of total billed charges,37.27% of total billed charges,460.67,37.27,,368.54,percent of total billed charges,37.27% of total billed charges,460.67,37.27,,368.54,percent of total billed charges,37.27% of total billed charges,193.09,75,,,fee schedule,75% of CMS fee schedule,193.09,75,,,fee schedule,75% of CMS fee schedule,257.45,100,,,fee schedule,100% of CMS fee schedule,257.45,100,,,fee schedule,100% of CMS fee schedule,193.09,75,,,fee schedule,75% of CMS fee schedule,193.09,75,,,fee schedule,75% of CMS fee schedule,257.45,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,494.41,40,,395.53,percent of total billed charges,40% of total billed charges,193.09,988.82,
LACTOFERRIN QUANT,7000029,CDM,301,RC,83631,HCPCS,Outpatient,,,94.26,75.41,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.41,80,,60.33,percent of total billed charges,80% of total billed charges,35.13,37.27,,28.1,percent of total billed charges,37.27% of total billed charges,35.13,37.27,,28.1,percent of total billed charges,37.27% of total billed charges,35.13,37.27,,28.1,percent of total billed charges,37.27% of total billed charges,14.72,75,,,fee schedule,75% of CMS fee schedule,14.72,75,,,fee schedule,75% of CMS fee schedule,19.63,100,,,fee schedule,100% of CMS fee schedule,19.63,100,,,fee schedule,100% of CMS fee schedule,14.72,75,,,fee schedule,75% of CMS fee schedule,14.72,75,,,fee schedule,75% of CMS fee schedule,19.63,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.7,40,,30.16,percent of total billed charges,40% of total billed charges,14.72,75.41,
DRUG SC 7PL CLIENT,7000029,CDM,301,RC,80307,HCPCS,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,46.61,75,,,fee schedule,75% of CMS fee schedule,46.61,75,,,fee schedule,75% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,46.61,75,,,fee schedule,75% of CMS fee schedule,46.61,75,,,fee schedule,75% of CMS fee schedule,62.14,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,62.14,
GALECTIN-3,7000029,CDM,301,RC,82777,HCPCS,Outpatient,,,105.6,84.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.48,80,,67.58,percent of total billed charges,80% of total billed charges,39.36,37.27,,31.49,percent of total billed charges,37.27% of total billed charges,39.36,37.27,,31.49,percent of total billed charges,37.27% of total billed charges,39.36,37.27,,31.49,percent of total billed charges,37.27% of total billed charges,33.19,75,,,fee schedule,75% of CMS fee schedule,33.19,75,,,fee schedule,75% of CMS fee schedule,44.25,100,,,fee schedule,100% of CMS fee schedule,44.25,100,,,fee schedule,100% of CMS fee schedule,33.19,75,,,fee schedule,75% of CMS fee schedule,33.19,75,,,fee schedule,75% of CMS fee schedule,44.25,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.24,40,,33.79,percent of total billed charges,40% of total billed charges,33.19,84.48,
PNEUMOCOCCAL AB,7000169,CDM,302,RC,86609,HCPCS,Outpatient,,,95,76.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,9.66,75,,,fee schedule,75% of CMS fee schedule,12.88,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38,40,,30.4,percent of total billed charges,40% of total billed charges,9.66,76,
RETIC AUTOMATED,7000177,CDM,305,RC,85045,HCPCS,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,2.99,75,,,fee schedule,75% of CMS fee schedule,2.99,75,,,fee schedule,75% of CMS fee schedule,3.99,100,,,fee schedule,100% of CMS fee schedule,3.99,100,,,fee schedule,100% of CMS fee schedule,2.99,75,,,fee schedule,75% of CMS fee schedule,2.99,75,,,fee schedule,75% of CMS fee schedule,3.99,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,2.99,11.2,
"GLUCOSE, ACCUCHECK",7012032,CDM,300,RC,82962,HCPCS,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,2.46,75,,,fee schedule,75% of CMS fee schedule,3.28,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,2.46,13.6,
PROCALCITONIN,7000029,CDM,301,RC,84145,HCPCS,Outpatient,,,110.25,88.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.2,80,,70.56,percent of total billed charges,80% of total billed charges,41.09,37.27,,32.87,percent of total billed charges,37.27% of total billed charges,41.09,37.27,,32.87,percent of total billed charges,37.27% of total billed charges,41.09,37.27,,32.87,percent of total billed charges,37.27% of total billed charges,20.42,75,,,fee schedule,75% of CMS fee schedule,20.42,75,,,fee schedule,75% of CMS fee schedule,27.22,100,,,fee schedule,100% of CMS fee schedule,27.22,100,,,fee schedule,100% of CMS fee schedule,20.42,75,,,fee schedule,75% of CMS fee schedule,20.42,75,,,fee schedule,75% of CMS fee schedule,27.22,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.1,40,,35.28,percent of total billed charges,40% of total billed charges,20.42,88.2,
GLUTATHIONE,7000029,CDM,301,RC,82978,HCPCS,Outpatient,,,58.65,46.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.92,80,,37.54,percent of total billed charges,80% of total billed charges,21.86,37.27,,17.49,percent of total billed charges,37.27% of total billed charges,21.86,37.27,,17.49,percent of total billed charges,37.27% of total billed charges,21.86,37.27,,17.49,percent of total billed charges,37.27% of total billed charges,11.59,75,,,fee schedule,75% of CMS fee schedule,11.59,75,,,fee schedule,75% of CMS fee schedule,15.45,100,,,fee schedule,100% of CMS fee schedule,15.45,100,,,fee schedule,100% of CMS fee schedule,11.59,75,,,fee schedule,75% of CMS fee schedule,11.59,75,,,fee schedule,75% of CMS fee schedule,15.45,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.46,40,,18.77,percent of total billed charges,40% of total billed charges,11.59,46.92,
BRAF GENE,7000029,CDM,301,RC,81210,HCPCS,Outpatient,,,450,360.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360,80,,288,percent of total billed charges,80% of total billed charges,167.72,37.27,,134.18,percent of total billed charges,37.27% of total billed charges,167.72,37.27,,134.18,percent of total billed charges,37.27% of total billed charges,167.72,37.27,,134.18,percent of total billed charges,37.27% of total billed charges,131.55,75,,,fee schedule,75% of CMS fee schedule,131.55,75,,,fee schedule,75% of CMS fee schedule,175.4,100,,,fee schedule,100% of CMS fee schedule,175.4,100,,,fee schedule,100% of CMS fee schedule,131.55,75,,,fee schedule,75% of CMS fee schedule,131.55,75,,,fee schedule,75% of CMS fee schedule,175.4,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,40,,144,percent of total billed charges,40% of total billed charges,131.55,360,
COLD AGGLUTININ SCRE,7000169,CDM,302,RC,86156,HCPCS,Outpatient,,,25,20.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,6.05,75,,,fee schedule,75% of CMS fee schedule,6.05,75,,,fee schedule,75% of CMS fee schedule,8.07,100,,,fee schedule,100% of CMS fee schedule,8.07,100,,,fee schedule,100% of CMS fee schedule,6.05,75,,,fee schedule,75% of CMS fee schedule,6.05,75,,,fee schedule,75% of CMS fee schedule,8.07,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,6.05,20,
"ID BY DNA/PCR,EA ORG",7000284,CDM,306,RC,87150,HCPCS,Outpatient,,,120.35,96.28,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.28,80,,77.02,percent of total billed charges,80% of total billed charges,44.85,37.27,,35.88,percent of total billed charges,37.27% of total billed charges,44.85,37.27,,35.88,percent of total billed charges,37.27% of total billed charges,44.85,37.27,,35.88,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.14,40,,38.51,percent of total billed charges,40% of total billed charges,26.32,96.28,
SHIGA-LIKE TOXIN,7000284,CDM,306,RC,87427,HCPCS,Outpatient,,,41.1,32.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.88,80,,26.3,percent of total billed charges,80% of total billed charges,15.32,37.27,,12.26,percent of total billed charges,37.27% of total billed charges,15.32,37.27,,12.26,percent of total billed charges,37.27% of total billed charges,15.32,37.27,,12.26,percent of total billed charges,37.27% of total billed charges,8.99,75,,,fee schedule,75% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,8.99,75,,,fee schedule,75% of CMS fee schedule,11.98,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.44,40,,13.15,percent of total billed charges,40% of total billed charges,8.99,32.88,
OB VENIPUNCTURE,7012032,CDM,300,RC,36415,HCPCS,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,6.62,20,
VENIPUNCT NBN NURS,7012032,CDM,300,RC,36415,HCPCS,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,6.62,20,
COVID-19 TESTING,7000284,CDM,306,RC,87635,HCPCS,Outpatient,,,150,120.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,38.48,75,,,fee schedule,75% of CMS fee schedule,38.48,75,,,fee schedule,75% of CMS fee schedule,51.31,100,,,fee schedule,100% of CMS fee schedule,51.31,100,,,fee schedule,100% of CMS fee schedule,38.48,75,,,fee schedule,75% of CMS fee schedule,38.48,75,,,fee schedule,75% of CMS fee schedule,51.31,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,40,,48,percent of total billed charges,40% of total billed charges,38.48,120,
LACOSAMIDE TEST,7000029,CDM,301,RC,80235,HCPCS,Outpatient,,,150,120.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,20.33,75,,,fee schedule,75% of CMS fee schedule,20.33,75,,,fee schedule,75% of CMS fee schedule,27.11,100,,,fee schedule,100% of CMS fee schedule,27.11,100,,,fee schedule,100% of CMS fee schedule,20.33,75,,,fee schedule,75% of CMS fee schedule,20.33,75,,,fee schedule,75% of CMS fee schedule,27.11,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,40,,48,percent of total billed charges,40% of total billed charges,20.33,120,
COVID19 ANTIBODY TES,7000284,CDM,306,RC,86769,HCPCS,Outpatient,,,150,120.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,31.6,75,,,fee schedule,75% of CMS fee schedule,31.6,75,,,fee schedule,75% of CMS fee schedule,42.13,100,,,fee schedule,100% of CMS fee schedule,42.13,100,,,fee schedule,100% of CMS fee schedule,31.6,75,,,fee schedule,75% of CMS fee schedule,31.6,75,,,fee schedule,75% of CMS fee schedule,42.13,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,40,,48,percent of total billed charges,40% of total billed charges,31.6,120,
ALLERGEN PROF IGE EA,7000169,CDM,302,RC,86003,HCPCS,Outpatient,,,8.7,6.96,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.96,80,,5.57,percent of total billed charges,80% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% of total billed charges,3.92,75,,,fee schedule,75% of CMS fee schedule,3.92,75,,,fee schedule,75% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,3.92,75,,,fee schedule,75% of CMS fee schedule,3.92,75,,,fee schedule,75% of CMS fee schedule,5.22,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.48,40,,2.78,percent of total billed charges,40% of total billed charges,3.24,6.96,
CARBOHYD DEFICIENT,7000029,CDM,301,RC,82373,HCPCS,Outpatient,,,118,94.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,13.55,75,,,fee schedule,75% of CMS fee schedule,13.55,75,,,fee schedule,75% of CMS fee schedule,18.06,100,,,fee schedule,100% of CMS fee schedule,18.06,100,,,fee schedule,100% of CMS fee schedule,13.55,75,,,fee schedule,75% of CMS fee schedule,13.55,75,,,fee schedule,75% of CMS fee schedule,18.06,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,40,,37.76,percent of total billed charges,40% of total billed charges,13.55,94.4,
HIV-2 QPCR,7000284,CDM,306,RC,87538,HCPCS,Outpatient,,,150,120.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,40,,48,percent of total billed charges,40% of total billed charges,26.32,120,
BRCA1/2 COMP ANALYSI,7000029,CDM,301,RC,81162,HCPCS,Outpatient,,,4562,3649.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3649.6,80,,2919.68,percent of total billed charges,80% of total billed charges,1700.26,37.27,,1360.21,percent of total billed charges,37.27% of total billed charges,1700.26,37.27,,1360.21,percent of total billed charges,37.27% of total billed charges,1700.26,37.27,,1360.21,percent of total billed charges,37.27% of total billed charges,1368.66,75,,,fee schedule,75% of CMS fee schedule,1368.66,75,,,fee schedule,75% of CMS fee schedule,1824.88,100,,,fee schedule,100% of CMS fee schedule,1824.88,100,,,fee schedule,100% of CMS fee schedule,1368.66,75,,,fee schedule,75% of CMS fee schedule,1368.66,75,,,fee schedule,75% of CMS fee schedule,1824.88,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1824.8,40,,1459.84,percent of total billed charges,40% of total billed charges,1368.66,3649.6,
DRUG 8-14 DEFINITIVE,7000029,CDM,301,RC,G0481,HCPCS,Outpatient,,,390,312.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,312,80,,249.6,percent of total billed charges,80% of total billed charges,145.35,37.27,,116.28,percent of total billed charges,37.27% of total billed charges,145.35,37.27,,116.28,percent of total billed charges,37.27% of total billed charges,145.35,37.27,,116.28,percent of total billed charges,37.27% of total billed charges,117.44,75,,,fee schedule,75% of CMS fee schedule,117.44,75,,,fee schedule,75% of CMS fee schedule,156.59,100,,,fee schedule,100% of CMS fee schedule,156.59,100,,,fee schedule,100% of CMS fee schedule,117.44,75,,,fee schedule,75% of CMS fee schedule,117.44,75,,,fee schedule,75% of CMS fee schedule,156.59,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156,40,,124.8,percent of total billed charges,40% of total billed charges,117.44,312,
RAPID COVID 19 TEST,7000284,CDM,306,RC,87635,HCPCS,Outpatient,,,165,132.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,38.48,75,,,fee schedule,75% of CMS fee schedule,38.48,75,,,fee schedule,75% of CMS fee schedule,51.31,100,,,fee schedule,100% of CMS fee schedule,51.31,100,,,fee schedule,100% of CMS fee schedule,38.48,75,,,fee schedule,75% of CMS fee schedule,38.48,75,,,fee schedule,75% of CMS fee schedule,51.31,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,40,,52.8,percent of total billed charges,40% of total billed charges,38.48,132,
RESPIR PANEL W/O RSV,7000029,CDM,301,RC,87636,HCPCS,Outpatient,,,249,199.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.2,80,,159.36,percent of total billed charges,80% of total billed charges,92.8,37.27,,74.24,percent of total billed charges,37.27% of total billed charges,92.8,37.27,,74.24,percent of total billed charges,37.27% of total billed charges,92.8,37.27,,74.24,percent of total billed charges,37.27% of total billed charges,106.97,75,,,fee schedule,75% of CMS fee schedule,106.97,75,,,fee schedule,75% of CMS fee schedule,142.63,100,,,fee schedule,100% of CMS fee schedule,142.63,100,,,fee schedule,100% of CMS fee schedule,106.97,75,,,fee schedule,75% of CMS fee schedule,106.97,75,,,fee schedule,75% of CMS fee schedule,142.63,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.6,40,,79.68,percent of total billed charges,40% of total billed charges,92.8,199.2,
RESP PANEL W/RSV,7000029,CDM,301,RC,87637,HCPCS,Outpatient,,,249,199.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.2,80,,159.36,percent of total billed charges,80% of total billed charges,92.8,37.27,,74.24,percent of total billed charges,37.27% of total billed charges,92.8,37.27,,74.24,percent of total billed charges,37.27% of total billed charges,92.8,37.27,,74.24,percent of total billed charges,37.27% of total billed charges,106.97,75,,,fee schedule,75% of CMS fee schedule,106.97,75,,,fee schedule,75% of CMS fee schedule,142.63,100,,,fee schedule,100% of CMS fee schedule,142.63,100,,,fee schedule,100% of CMS fee schedule,106.97,75,,,fee schedule,75% of CMS fee schedule,106.97,75,,,fee schedule,75% of CMS fee schedule,142.63,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.6,40,,79.68,percent of total billed charges,40% of total billed charges,92.8,199.2,
WRIST PRO SPLINT 10,8100075,CDM,274,RC,L3908,HCPCS,Outpatient,,,75,60.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,80,,48,percent of total billed charges,80% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% of total billed charges,54.32,75,,,fee schedule,75% of CMS fee schedule,54.32,75,,,fee schedule,75% of CMS fee schedule,72.42,100,,,fee schedule,100% of CMS fee schedule,72.42,100,,,fee schedule,100% of CMS fee schedule,54.32,75,,,fee schedule,75% of CMS fee schedule,54.32,75,,,fee schedule,75% of CMS fee schedule,72.42,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,40,,24,percent of total billed charges,40% of total billed charges,27.95,72.42,
GASTROINT PROF 12-25,7000284,CDM,306,RC,87507,HCPCS,Outpatient,,,700,560.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,560,80,,448,percent of total billed charges,80% of total billed charges,260.89,37.27,,208.71,percent of total billed charges,37.27% of total billed charges,260.89,37.27,,208.71,percent of total billed charges,37.27% of total billed charges,260.89,37.27,,208.71,percent of total billed charges,37.27% of total billed charges,312.59,75,,,fee schedule,75% of CMS fee schedule,312.59,75,,,fee schedule,75% of CMS fee schedule,416.78,100,,,fee schedule,100% of CMS fee schedule,416.78,100,,,fee schedule,100% of CMS fee schedule,312.59,75,,,fee schedule,75% of CMS fee schedule,312.59,75,,,fee schedule,75% of CMS fee schedule,416.78,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,40,,224,percent of total billed charges,40% of total billed charges,260.89,560,
STREP A MOLECULAR,7000284,CDM,306,RC,87651,HCPCS,Outpatient,,,62,49.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,26.32,75,,,fee schedule,75% of CMS fee schedule,35.09,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,40,,19.84,percent of total billed charges,40% of total billed charges,23.11,49.6,
HEP B SURF AG NON OB,7000029,CDM,301,RC,87350,HCPCS,Outpatient,,,59,47.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,8.65,75,,,fee schedule,75% of CMS fee schedule,11.53,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.6,40,,18.88,percent of total billed charges,40% of total billed charges,8.65,47.2,
CRYOFIBRINOGEN,7000029,CDM,301,RC,82585,HCPCS,Outpatient,,,52,41.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,10.61,75,,,fee schedule,75% of CMS fee schedule,10.61,75,,,fee schedule,75% of CMS fee schedule,14.14,100,,,fee schedule,100% of CMS fee schedule,14.14,100,,,fee schedule,100% of CMS fee schedule,10.61,75,,,fee schedule,75% of CMS fee schedule,10.61,75,,,fee schedule,75% of CMS fee schedule,14.14,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,40,,16.64,percent of total billed charges,40% of total billed charges,10.61,41.6,
VENIPUNCTURE MEDSURG,7012032,CDM,300,RC,36415,HCPCS,Outpatient,,,25,20.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,6.62,20,
VENIPUNCTURE ICU,7012032,CDM,300,RC,36415,HCPCS,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,6.62,20,
TELE VENIPUNCTURE,7012032,CDM,300,RC,36415,HCPCS,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,40,,8,percent of total billed charges,40% of total billed charges,6.62,20,
ENHANCED LIVER FIBRO,7000029,CDM,301,RC,81517,HCPCS,Outpatient,,,324,259.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.2,80,,207.36,percent of total billed charges,80% of total billed charges,120.75,37.27,,96.6,percent of total billed charges,37.27% of total billed charges,120.75,37.27,,96.6,percent of total billed charges,37.27% of total billed charges,120.75,37.27,,96.6,percent of total billed charges,37.27% of total billed charges,132.14,75,,,fee schedule,75% of CMS fee schedule,132.14,75,,,fee schedule,75% of CMS fee schedule,176.19,100,,,fee schedule,100% of CMS fee schedule,176.19,100,,,fee schedule,100% of CMS fee schedule,132.14,75,,,fee schedule,75% of CMS fee schedule,132.14,75,,,fee schedule,75% of CMS fee schedule,176.19,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,40,,103.68,percent of total billed charges,40% of total billed charges,120.75,259.2,
INSULIN FREE,7000169,CDM,302,RC,83527,HCPCS,Outpatient,,,55,44.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,9.71,75,,,fee schedule,75% of CMS fee schedule,9.71,75,,,fee schedule,75% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,9.71,75,,,fee schedule,75% of CMS fee schedule,9.71,75,,,fee schedule,75% of CMS fee schedule,12.95,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22,40,,17.6,percent of total billed charges,40% of total billed charges,9.71,44,
HEMOCCULT BLOOD TEST,7012032,CDM,300,RC,82272,HCPCS,Outpatient,,,18,14.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,3.17,75,,,fee schedule,75% of CMS fee schedule,3.17,75,,,fee schedule,75% of CMS fee schedule,4.23,100,,,fee schedule,100% of CMS fee schedule,4.23,100,,,fee schedule,100% of CMS fee schedule,3.17,75,,,fee schedule,75% of CMS fee schedule,3.17,75,,,fee schedule,75% of CMS fee schedule,4.23,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,3.17,14.4,
ATON HLTH COLLECTION,7012032,CDM,300,RC,36415,HCPCS,Outpatient,,,50,40.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,6.62,75,,,fee schedule,75% of CMS fee schedule,8.83,100,,,fee schedule,100% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,40,,16,percent of total billed charges,40% of total billed charges,6.62,40,
OT JOBST PRESSURE,6510135,CDM,430,RC,97016,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,15.99,145,,,fee schedule,145% of CMS fee schedule,15.99,145,,,fee schedule,145% of CMS fee schedule,15.99,145,,,fee schedule,145% of CMS fee schedule,15.99,100,,,per diem,pays based on per day rate,15.99,145,,,fee schedule,145% of CMS fee schedule,15.99,145,,,fee schedule,145% of CMS fee schedule,15.99,100,,,per diem,pays based on per day rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,15.99,62.4,
OT PARAFFIN BATH,6510135,CDM,430,RC,97018,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,7.67,145,,,fee schedule,145% of CMS fee schedule,7.67,145,,,fee schedule,145% of CMS fee schedule,7.67,145,,,fee schedule,145% of CMS fee schedule,7.67,145,,,fee schedule,145% of CMS fee schedule,7.67,145,,,fee schedule,145% of CMS fee schedule,7.67,145,,,fee schedule,145% of CMS fee schedule,7.67,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,7.67,62.4,
OT HOME ADL EA 15M,6510135,CDM,430,RC,97535,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,44.25,145,,,fee schedule,145% of CMS fee schedule,44.25,145,,,fee schedule,145% of CMS fee schedule,44.25,145,,,fee schedule,145% of CMS fee schedule,44.25,145,,,fee schedule,145% of CMS fee schedule,44.25,145,,,fee schedule,145% of CMS fee schedule,44.25,145,,,fee schedule,145% of CMS fee schedule,44.25,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,62.4,
OT THER ACT EA 15M,6510135,CDM,430,RC,97530,HCPCS,Outpatient,,,112,89.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,40,,35.84,percent of total billed charges,40% of total billed charges,41.74,89.6,
OT ESTIM ATTEND EA 1,6510135,CDM,430,RC,97032,HCPCS,Outpatient,,,78,62.40,GO,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,19.79,62.4,
JOBST PRESSURE TX,6610133,CDM,420,RC,97016,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,15.99,145,,,fee schedule,145% of CMS fee schedule,15.99,145,,,fee schedule,145% of CMS fee schedule,15.99,145,,,fee schedule,145% of CMS fee schedule,15.99,145,,,fee schedule,145% of CMS fee schedule,15.99,145,,,fee schedule,145% of CMS fee schedule,15.99,145,,,fee schedule,145% of CMS fee schedule,15.99,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,15.99,62.4,
PT TRACTION MECHANIC,6610133,CDM,420,RC,97012,HCPCS,Outpatient,,,34,27.20,GP,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,19.37,145,,,fee schedule,145% of CMS fee schedule,19.37,145,,,fee schedule,145% of CMS fee schedule,19.37,145,,,fee schedule,145% of CMS fee schedule,19.37,145,,,fee schedule,145% of CMS fee schedule,19.37,145,,,fee schedule,145% of CMS fee schedule,19.37,145,,,fee schedule,145% of CMS fee schedule,19.37,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,12.67,27.2,
IONTOPHOR EA 15 MIN,6610133,CDM,420,RC,97033,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,26.2,145,,,fee schedule,145% of CMS fee schedule,26.2,145,,,fee schedule,145% of CMS fee schedule,26.2,145,,,fee schedule,145% of CMS fee schedule,26.2,145,,,fee schedule,145% of CMS fee schedule,26.2,145,,,fee schedule,145% of CMS fee schedule,26.2,145,,,fee schedule,145% of CMS fee schedule,26.2,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,26.2,62.4,
TRACTION CERVICAL,6610133,CDM,420,RC,97012,HCPCS,Outpatient,,,34,27.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,19.37,145,,,fee schedule,145% of CMS fee schedule,19.37,145,,,fee schedule,145% of CMS fee schedule,19.37,145,,,fee schedule,145% of CMS fee schedule,19.37,145,,,fee schedule,145% of CMS fee schedule,19.37,145,,,fee schedule,145% of CMS fee schedule,19.37,145,,,fee schedule,145% of CMS fee schedule,19.37,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,12.67,27.2,
PT THER EX EA 15 MIN,6610133,CDM,420,RC,97110,HCPCS,Outpatient,,,78,62.40,GP,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,62.4,
ORTH INIT ENC EA 15,6610133,CDM,420,RC,97760,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,63.58,145,,,fee schedule,145% of CMS fee schedule,63.58,145,,,fee schedule,145% of CMS fee schedule,63.58,145,,,fee schedule,145% of CMS fee schedule,63.58,145,,,fee schedule,145% of CMS fee schedule,63.58,145,,,fee schedule,145% of CMS fee schedule,63.58,145,,,fee schedule,145% of CMS fee schedule,63.58,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,63.58,
PT FLUIDOTHERAPY,6610133,CDM,420,RC,97022,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,22.71,145,,,fee schedule,145% of CMS fee schedule,22.71,145,,,fee schedule,145% of CMS fee schedule,22.71,145,,,fee schedule,145% of CMS fee schedule,22.71,145,,,fee schedule,145% of CMS fee schedule,22.71,145,,,fee schedule,145% of CMS fee schedule,22.71,145,,,fee schedule,145% of CMS fee schedule,22.71,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,22.71,62.4,
PT MANUAL THER EA 15,6610133,CDM,420,RC,97140,HCPCS,Outpatient,,,78,62.40,GP,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,62.4,
PROSTH INIT EA 15,6610133,CDM,420,RC,97761,HCPCS,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,55.97,145,,,fee schedule,145% of CMS fee schedule,55.97,145,,,fee schedule,145% of CMS fee schedule,55.97,145,,,fee schedule,145% of CMS fee schedule,55.97,145,,,fee schedule,145% of CMS fee schedule,55.97,145,,,fee schedule,145% of CMS fee schedule,55.97,145,,,fee schedule,145% of CMS fee schedule,55.97,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34,40,,27.2,percent of total billed charges,40% of total billed charges,31.68,68,
PT ULTRAS EA 15,6610133,CDM,420,RC,97035,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,19.14,145,,,fee schedule,145% of CMS fee schedule,19.14,145,,,fee schedule,145% of CMS fee schedule,19.14,145,,,fee schedule,145% of CMS fee schedule,19.14,145,,,fee schedule,145% of CMS fee schedule,19.14,145,,,fee schedule,145% of CMS fee schedule,19.14,145,,,fee schedule,145% of CMS fee schedule,19.14,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,19.14,62.4,
PT JOBST MEAS EA 15,6610133,CDM,420,RC,97530,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,62.4,
PT TX EXER EA 15 MIN,6610133,CDM,420,RC,97110,HCPCS,Outpatient,,,119,95.20,GP,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.6,40,,38.08,percent of total billed charges,40% of total billed charges,40.02,95.2,
PT GAIT TRAIN EA 15,6610133,CDM,420,RC,97116,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,62.4,
PT SOFT TISS EA 15,6610133,CDM,420,RC,97140,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,62.4,
PT NEUROMUS ED EA 15,6610133,CDM,420,RC,97112,HCPCS,Outpatient,,,78,62.40,GP,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,45.82,145,,,fee schedule,145% of CMS fee schedule,45.82,145,,,fee schedule,145% of CMS fee schedule,45.82,145,,,fee schedule,145% of CMS fee schedule,45.82,145,,,fee schedule,145% of CMS fee schedule,45.82,145,,,fee schedule,145% of CMS fee schedule,45.82,145,,,fee schedule,145% of CMS fee schedule,45.82,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,62.4,
PT MASSAGE EA 15 MIN,6610133,CDM,420,RC,97124,HCPCS,Outpatient,,,78,62.40,GP,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,40.69,145,,,fee schedule,145% of CMS fee schedule,40.69,145,,,fee schedule,145% of CMS fee schedule,40.69,145,,,fee schedule,145% of CMS fee schedule,40.69,145,,,fee schedule,145% of CMS fee schedule,40.69,145,,,fee schedule,145% of CMS fee schedule,40.69,145,,,fee schedule,145% of CMS fee schedule,40.69,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,62.4,
PT PARAFFIN PER UNIT,6610133,CDM,420,RC,97018,HCPCS,Outpatient,,,78,62.40,GP,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,7.67,145,,,fee schedule,145% of CMS fee schedule,7.67,145,,,fee schedule,145% of CMS fee schedule,7.67,145,,,fee schedule,145% of CMS fee schedule,7.67,145,,,fee schedule,145% of CMS fee schedule,7.67,145,,,fee schedule,145% of CMS fee schedule,7.67,145,,,fee schedule,145% of CMS fee schedule,7.67,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,7.67,62.4,
OT FLUIDOTHERAPY,6510135,CDM,430,RC,97022,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,22.71,145,,,fee schedule,145% of CMS fee schedule,22.71,145,,,fee schedule,145% of CMS fee schedule,22.71,145,,,fee schedule,145% of CMS fee schedule,22.71,145,,,fee schedule,145% of CMS fee schedule,22.71,145,,,fee schedule,145% of CMS fee schedule,22.71,145,,,fee schedule,145% of CMS fee schedule,22.71,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,22.71,62.4,
PT ESTIM PER 15 MIN,6610133,CDM,420,RC,97032,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,19.79,62.4,
PT THER ACT EA 15 M,6610133,CDM,420,RC,97530,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,62.4,
PT EST ATTEND PER 15,6610133,CDM,420,RC,97032,HCPCS,Outpatient,,,78,62.40,GP,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,19.79,62.4,
ST TREATMNT/COMM DIS,6739429,CDM,440,RC,92507,HCPCS,Outpatient,,,220,176.00,GN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176,80,,140.8,percent of total billed charges,80% of total billed charges,81.99,37.27,,65.59,percent of total billed charges,37.27% of total billed charges,81.99,37.27,,65.59,percent of total billed charges,37.27% of total billed charges,81.99,37.27,,65.59,percent of total billed charges,37.27% of total billed charges,104.98,145,,,fee schedule,145% of CMS fee schedule,104.98,145,,,fee schedule,145% of CMS fee schedule,104.98,145,,,fee schedule,145% of CMS fee schedule,104.98,145,,,fee schedule,145% of CMS fee schedule,104.98,145,,,fee schedule,145% of CMS fee schedule,104.98,145,,,fee schedule,145% of CMS fee schedule,104.98,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,40,,70.4,percent of total billed charges,40% of total billed charges,81.99,176,
ST EVAL SWALLOWING 1,6739445,CDM,444,RC,92610,HCPCS,Outpatient,,,224,179.20,GN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.2,80,,143.36,percent of total billed charges,80% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% of total billed charges,97.08,145,,,fee schedule,145% of CMS fee schedule,97.08,145,,,fee schedule,145% of CMS fee schedule,97.08,145,,,fee schedule,145% of CMS fee schedule,97.08,145,,,fee schedule,145% of CMS fee schedule,97.08,145,,,fee schedule,145% of CMS fee schedule,97.08,145,,,fee schedule,145% of CMS fee schedule,97.08,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,40,,71.68,percent of total billed charges,40% of total billed charges,83.48,179.2,
ST TREAT SWALLOW/ORA,6739429,CDM,440,RC,92526,HCPCS,Outpatient,,,197,157.60,GN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,115.8,145,,,fee schedule,145% of CMS fee schedule,115.8,145,,,fee schedule,145% of CMS fee schedule,115.8,145,,,fee schedule,145% of CMS fee schedule,115.8,145,,,fee schedule,145% of CMS fee schedule,115.8,145,,,fee schedule,145% of CMS fee schedule,115.8,145,,,fee schedule,145% of CMS fee schedule,115.8,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.8,40,,63.04,percent of total billed charges,40% of total billed charges,73.42,157.6,
OT THERA ?RPC GROUP,6510135,CDM,430,RC,97150,HCPCS,Outpatient,,,268,214.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,214.4,80,,171.52,percent of total billed charges,80% of total billed charges,99.88,37.27,,79.9,percent of total billed charges,37.27% of total billed charges,99.88,37.27,,79.9,percent of total billed charges,37.27% of total billed charges,99.88,37.27,,79.9,percent of total billed charges,37.27% of total billed charges,24.69,145,,,fee schedule,145% of CMS fee schedule,24.69,145,,,fee schedule,145% of CMS fee schedule,24.69,145,,,fee schedule,145% of CMS fee schedule,24.69,145,,,fee schedule,145% of CMS fee schedule,24.69,145,,,fee schedule,145% of CMS fee schedule,24.69,145,,,fee schedule,145% of CMS fee schedule,24.69,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.2,40,,85.76,percent of total billed charges,40% of total billed charges,24.69,214.4,
OT ULTRAS EA 15 MIN,6510135,CDM,430,RC,97035,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,19.14,145,,,fee schedule,145% of CMS fee schedule,19.14,145,,,fee schedule,145% of CMS fee schedule,19.14,145,,,fee schedule,145% of CMS fee schedule,19.14,145,,,fee schedule,145% of CMS fee schedule,19.14,145,,,fee schedule,145% of CMS fee schedule,19.14,145,,,fee schedule,145% of CMS fee schedule,19.14,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,19.14,62.4,
IND MNT INIT EA 15,4418307,CDM,942,RC,97802,HCPCS,Outpatient,,,77,61.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,43.46,145,,,fee schedule,145% of CMS fee schedule,43.46,145,,,fee schedule,145% of CMS fee schedule,43.46,145,,,fee schedule,145% of CMS fee schedule,43.46,145,,,fee schedule,145% of CMS fee schedule,43.46,145,,,fee schedule,145% of CMS fee schedule,43.46,145,,,fee schedule,145% of CMS fee schedule,43.46,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,28.7,61.6,
IND MNT SUBS EA 15,4418307,CDM,942,RC,97803,HCPCS,Outpatient,,,71,56.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,37.06,145,,,fee schedule,145% of CMS fee schedule,37.06,145,,,fee schedule,145% of CMS fee schedule,37.06,145,,,fee schedule,145% of CMS fee schedule,37.06,145,,,fee schedule,145% of CMS fee schedule,37.06,145,,,fee schedule,145% of CMS fee schedule,37.06,145,,,fee schedule,145% of CMS fee schedule,37.06,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.4,40,,22.72,percent of total billed charges,40% of total billed charges,26.46,56.8,
GRP MNT EA 30 MINS,4418307,CDM,942,RC,97804,HCPCS,Outpatient,,,41,32.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,21.07,145,,,fee schedule,145% of CMS fee schedule,21.07,145,,,fee schedule,145% of CMS fee schedule,21.07,145,,,fee schedule,145% of CMS fee schedule,21.07,145,,,fee schedule,145% of CMS fee schedule,21.07,145,,,fee schedule,145% of CMS fee schedule,21.07,145,,,fee schedule,145% of CMS fee schedule,21.07,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,15.28,32.8,
GRP DIAB TRNG PER 30,4418307,CDM,942,RC,G0109,HCPCS,Outpatient,,,31,24.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,21.49,145,,,fee schedule,145% of CMS fee schedule,21.49,145,,,fee schedule,145% of CMS fee schedule,21.49,145,,,fee schedule,145% of CMS fee schedule,21.49,145,,,fee schedule,145% of CMS fee schedule,21.49,145,,,fee schedule,145% of CMS fee schedule,21.49,145,,,fee schedule,145% of CMS fee schedule,21.49,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,11.55,24.8,
MAMMO BILAT DIAG DIG,6001815,CDM,401,RC,77066,HCPCS,Outpatient,,,428,342.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,342.4,80,,273.92,percent of total billed charges,80% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,142.32,145,,,fee schedule,145% of CMS fee schedule,142.32,145,,,fee schedule,145% of CMS fee schedule,142.32,145,,,fee schedule,145% of CMS fee schedule,142.32,145,,,fee schedule,145% of CMS fee schedule,142.32,145,,,fee schedule,145% of CMS fee schedule,142.32,145,,,fee schedule,145% of CMS fee schedule,142.32,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.2,40,,136.96,percent of total billed charges,40% of total billed charges,142.32,342.4,
MAMMO UNIL DIAG DIG,6001815,CDM,401,RC,77065,HCPCS,Outpatient,,,286,228.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,110.9,145,,,fee schedule,145% of CMS fee schedule,110.9,145,,,fee schedule,145% of CMS fee schedule,110.9,145,,,fee schedule,145% of CMS fee schedule,110.9,145,,,fee schedule,145% of CMS fee schedule,110.9,145,,,fee schedule,145% of CMS fee schedule,110.9,145,,,fee schedule,145% of CMS fee schedule,110.9,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.4,40,,91.52,percent of total billed charges,40% of total billed charges,106.59,228.8,
MAMMO BIL SCR W/CAD,6001835,CDM,403,RC,77067,HCPCS,Outpatient,,,393,314.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.4,80,,251.52,percent of total billed charges,80% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% of total billed charges,117.25,145,,,fee schedule,145% of CMS fee schedule,117.25,145,,,fee schedule,145% of CMS fee schedule,117.25,145,,,fee schedule,145% of CMS fee schedule,117.25,145,,,fee schedule,145% of CMS fee schedule,117.25,145,,,fee schedule,145% of CMS fee schedule,117.25,145,,,fee schedule,145% of CMS fee schedule,117.25,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.2,40,,125.76,percent of total billed charges,40% of total billed charges,117.25,314.4,
EVAL SP FLUENCY,6739445,CDM,444,RC,92521,HCPCS,Outpatient,,,314,251.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,251.2,80,,200.96,percent of total billed charges,80% of total billed charges,117.03,37.27,,93.62,percent of total billed charges,37.27% of total billed charges,117.03,37.27,,93.62,percent of total billed charges,37.27% of total billed charges,117.03,37.27,,93.62,percent of total billed charges,37.27% of total billed charges,182.87,145,,,fee schedule,145% of CMS fee schedule,182.87,145,,,fee schedule,145% of CMS fee schedule,182.87,145,,,fee schedule,145% of CMS fee schedule,182.87,145,,,fee schedule,145% of CMS fee schedule,182.87,145,,,fee schedule,145% of CMS fee schedule,182.87,145,,,fee schedule,145% of CMS fee schedule,182.87,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.6,40,,100.48,percent of total billed charges,40% of total billed charges,117.03,251.2,
EVAL SP SOUND PROD,6739445,CDM,444,RC,92522,HCPCS,Outpatient,,,256,204.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.8,80,,163.84,percent of total billed charges,80% of total billed charges,95.41,37.27,,76.33,percent of total billed charges,37.27% of total billed charges,95.41,37.27,,76.33,percent of total billed charges,37.27% of total billed charges,95.41,37.27,,76.33,percent of total billed charges,37.27% of total billed charges,153.61,145,,,fee schedule,145% of CMS fee schedule,153.61,145,,,fee schedule,145% of CMS fee schedule,153.61,145,,,fee schedule,145% of CMS fee schedule,153.61,145,,,fee schedule,145% of CMS fee schedule,153.61,145,,,fee schedule,145% of CMS fee schedule,153.61,145,,,fee schedule,145% of CMS fee schedule,153.61,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.4,40,,81.92,percent of total billed charges,40% of total billed charges,95.41,204.8,
EVAL SP SND PROD ART,6739445,CDM,444,RC,92523,HCPCS,Outpatient,,,531,424.80,GN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,424.8,80,,339.84,percent of total billed charges,80% of total billed charges,197.9,37.27,,158.32,percent of total billed charges,37.27% of total billed charges,197.9,37.27,,158.32,percent of total billed charges,37.27% of total billed charges,197.9,37.27,,158.32,percent of total billed charges,37.27% of total billed charges,313.48,145,,,fee schedule,145% of CMS fee schedule,313.48,145,,,fee schedule,145% of CMS fee schedule,313.48,145,,,fee schedule,145% of CMS fee schedule,313.48,145,,,fee schedule,145% of CMS fee schedule,313.48,145,,,fee schedule,145% of CMS fee schedule,313.48,145,,,fee schedule,145% of CMS fee schedule,313.48,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,212.4,40,,169.92,percent of total billed charges,40% of total billed charges,197.9,424.8,
BEHAV-QUALITATIVE AN,6739445,CDM,444,RC,92524,HCPCS,Outpatient,,,267,213.60,GN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,213.6,80,,170.88,percent of total billed charges,80% of total billed charges,99.51,37.27,,79.61,percent of total billed charges,37.27% of total billed charges,99.51,37.27,,79.61,percent of total billed charges,37.27% of total billed charges,99.51,37.27,,79.61,percent of total billed charges,37.27% of total billed charges,151.5,145,,,fee schedule,145% of CMS fee schedule,151.5,145,,,fee schedule,145% of CMS fee schedule,151.5,145,,,fee schedule,145% of CMS fee schedule,151.5,145,,,fee schedule,145% of CMS fee schedule,151.5,145,,,fee schedule,145% of CMS fee schedule,151.5,145,,,fee schedule,145% of CMS fee schedule,151.5,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.8,40,,85.44,percent of total billed charges,40% of total billed charges,99.51,213.6,
OT MANUL THER EA 15M,6510135,CDM,430,RC,97140,HCPCS,Outpatient,,,78,62.40,GO,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,62.4,
OT HOT/COLD PACKS,6510135,CDM,430,RC,97010,HCPCS,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.51,145,,,fee schedule,145% of CMS fee schedule,8.51,145,,,fee schedule,145% of CMS fee schedule,8.51,145,,,fee schedule,145% of CMS fee schedule,8.51,145,,,fee schedule,145% of CMS fee schedule,8.51,145,,,fee schedule,145% of CMS fee schedule,8.51,145,,,fee schedule,145% of CMS fee schedule,8.51,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,8.51,19.2,
ORTH TRN INIT ENC EA,6510135,CDM,430,RC,97760,HCPCS,Outpatient,,,112,89.60,GO,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,63.58,145,,,fee schedule,145% of CMS fee schedule,63.58,145,,,fee schedule,145% of CMS fee schedule,63.58,145,,,fee schedule,145% of CMS fee schedule,63.58,145,,,fee schedule,145% of CMS fee schedule,63.58,145,,,fee schedule,145% of CMS fee schedule,63.58,145,,,fee schedule,145% of CMS fee schedule,63.58,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,40,,35.84,percent of total billed charges,40% of total billed charges,41.74,89.6,
OT THER EXER EA 15M,6510135,CDM,430,RC,97110,HCPCS,Outpatient,,,119,95.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.6,40,,38.08,percent of total billed charges,40% of total billed charges,40.02,95.2,
OT NEURMSC RE ED 15M,6510135,CDM,430,RC,97112,HCPCS,Outpatient,,,122,97.60,GO,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.82,145,,,fee schedule,145% of CMS fee schedule,45.82,145,,,fee schedule,145% of CMS fee schedule,45.82,145,,,fee schedule,145% of CMS fee schedule,45.82,145,,,fee schedule,145% of CMS fee schedule,45.82,145,,,fee schedule,145% of CMS fee schedule,45.82,145,,,fee schedule,145% of CMS fee schedule,45.82,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.8,40,,39.04,percent of total billed charges,40% of total billed charges,45.47,97.6,
OT SENS IN TECH 15M,6510135,CDM,430,RC,97533,HCPCS,Outpatient,,,108,86.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,82.06,145,,,fee schedule,145% of CMS fee schedule,82.06,145,,,fee schedule,145% of CMS fee schedule,82.06,145,,,fee schedule,145% of CMS fee schedule,82.06,145,,,fee schedule,145% of CMS fee schedule,82.06,145,,,fee schedule,145% of CMS fee schedule,82.06,145,,,fee schedule,145% of CMS fee schedule,82.06,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,40.25,86.4,
ST MOD BARI SWAL W/,6739445,CDM,444,RC,92611,HCPCS,Outpatient,,,322,257.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,120.01,37.27,,96.01,percent of total billed charges,37.27% of total billed charges,120.01,37.27,,96.01,percent of total billed charges,37.27% of total billed charges,120.01,37.27,,96.01,percent of total billed charges,37.27% of total billed charges,125.61,145,,,fee schedule,145% of CMS fee schedule,125.61,145,,,fee schedule,145% of CMS fee schedule,125.61,145,,,fee schedule,145% of CMS fee schedule,125.61,145,,,fee schedule,145% of CMS fee schedule,125.61,145,,,fee schedule,145% of CMS fee schedule,125.61,145,,,fee schedule,145% of CMS fee schedule,125.61,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.8,40,,103.04,percent of total billed charges,40% of total billed charges,120.01,257.6,
ST ASSES OF APHAS HR,6739445,CDM,444,RC,96105,HCPCS,Outpatient,,,388,310.40,GN,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,133.14,145,,,fee schedule,145% of CMS fee schedule,133.14,145,,,fee schedule,145% of CMS fee schedule,133.14,145,,,fee schedule,145% of CMS fee schedule,133.14,145,,,fee schedule,145% of CMS fee schedule,133.14,145,,,fee schedule,145% of CMS fee schedule,133.14,145,,,fee schedule,145% of CMS fee schedule,133.14,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.2,40,,124.16,percent of total billed charges,40% of total billed charges,133.14,310.4,
PT WHLCHR TRN EA 15M,6610133,CDM,420,RC,97542,HCPCS,Outpatient,,,112,89.60,GP,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,43.17,145,,,fee schedule,145% of CMS fee schedule,43.17,145,,,fee schedule,145% of CMS fee schedule,43.17,145,,,fee schedule,145% of CMS fee schedule,43.17,145,,,fee schedule,145% of CMS fee schedule,43.17,145,,,fee schedule,145% of CMS fee schedule,43.17,145,,,fee schedule,145% of CMS fee schedule,43.17,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,40,,35.84,percent of total billed charges,40% of total billed charges,41.74,89.6,
PT HOT/COLD PACKS,6610133,CDM,420,RC,97010,HCPCS,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.51,145,,,fee schedule,145% of CMS fee schedule,8.51,145,,,fee schedule,145% of CMS fee schedule,8.51,145,,,fee schedule,145% of CMS fee schedule,8.51,145,,,fee schedule,145% of CMS fee schedule,8.51,145,,,fee schedule,145% of CMS fee schedule,8.51,145,,,fee schedule,145% of CMS fee schedule,8.51,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,8.51,19.2,
PT EVAL LOW COMPLEXI,6639520,CDM,424,RC,97161,HCPCS,Outpatient,,,304,243.20,GP,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.2,80,,194.56,percent of total billed charges,80% of total billed charges,113.3,37.27,,90.64,percent of total billed charges,37.27% of total billed charges,113.3,37.27,,90.64,percent of total billed charges,37.27% of total billed charges,113.3,37.27,,90.64,percent of total billed charges,37.27% of total billed charges,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.6,40,,97.28,percent of total billed charges,40% of total billed charges,113.3,243.2,
PT EVAL MODERATE COM,6639520,CDM,424,RC,97162,HCPCS,Outpatient,,,304,243.20,GP,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.2,80,,194.56,percent of total billed charges,80% of total billed charges,113.3,37.27,,90.64,percent of total billed charges,37.27% of total billed charges,113.3,37.27,,90.64,percent of total billed charges,37.27% of total billed charges,113.3,37.27,,90.64,percent of total billed charges,37.27% of total billed charges,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.6,40,,97.28,percent of total billed charges,40% of total billed charges,113.3,243.2,
PT EVAL HIGH COMPLEX,6639520,CDM,424,RC,97163,HCPCS,Outpatient,,,304,243.20,GP,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.2,80,,194.56,percent of total billed charges,80% of total billed charges,113.3,37.27,,90.64,percent of total billed charges,37.27% of total billed charges,113.3,37.27,,90.64,percent of total billed charges,37.27% of total billed charges,113.3,37.27,,90.64,percent of total billed charges,37.27% of total billed charges,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,137,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.6,40,,97.28,percent of total billed charges,40% of total billed charges,113.3,243.2,
PT RE-EVAL EST PLAN,6639520,CDM,424,RC,97164,HCPCS,Outpatient,,,216,172.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.8,80,,138.24,percent of total billed charges,80% of total billed charges,80.5,37.27,,64.4,percent of total billed charges,37.27% of total billed charges,80.5,37.27,,64.4,percent of total billed charges,37.27% of total billed charges,80.5,37.27,,64.4,percent of total billed charges,37.27% of total billed charges,94.5,145,,,fee schedule,145% of CMS fee schedule,94.5,145,,,fee schedule,145% of CMS fee schedule,94.5,145,,,fee schedule,145% of CMS fee schedule,94.5,145,,,fee schedule,145% of CMS fee schedule,94.5,145,,,fee schedule,145% of CMS fee schedule,94.5,145,,,fee schedule,145% of CMS fee schedule,94.5,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,40,,69.12,percent of total billed charges,40% of total billed charges,80.5,172.8,
OT EVAL LOW COMPLEXI,6513436,CDM,434,RC,97165,HCPCS,Outpatient,,,312,249.60,GO,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,40,,99.84,percent of total billed charges,40% of total billed charges,116.28,249.6,
OT EVAL MODERATE COM,6513436,CDM,434,RC,97166,HCPCS,Outpatient,,,312,249.60,GO,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,40,,99.84,percent of total billed charges,40% of total billed charges,116.28,249.6,
OT EVAL HIGH COMPLEX,6513436,CDM,434,RC,97167,HCPCS,Outpatient,,,312,249.60,GO,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,138.26,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,40,,99.84,percent of total billed charges,40% of total billed charges,116.28,249.6,
OT RE-EVAL EST PL-CA,6513436,CDM,434,RC,97168,HCPCS,Outpatient,,,207,165.60,GO,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,77.15,37.27,,61.72,percent of total billed charges,37.27% of total billed charges,77.15,37.27,,61.72,percent of total billed charges,37.27% of total billed charges,77.15,37.27,,61.72,percent of total billed charges,37.27% of total billed charges,94.92,145,,,fee schedule,145% of CMS fee schedule,94.92,145,,,fee schedule,145% of CMS fee schedule,94.92,145,,,fee schedule,145% of CMS fee schedule,94.92,145,,,fee schedule,145% of CMS fee schedule,94.92,145,,,fee schedule,145% of CMS fee schedule,94.92,145,,,fee schedule,145% of CMS fee schedule,94.92,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.8,40,,66.24,percent of total billed charges,40% of total billed charges,77.15,165.6,
MAMMO BI 3D SCR TOMO,6001835,CDM,403,RC,77063,HCPCS,Outpatient,,,115,92.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,30.44,145,,,fee schedule,145% of CMS fee schedule,30.44,145,,,fee schedule,145% of CMS fee schedule,30.44,145,,,fee schedule,145% of CMS fee schedule,30.44,145,,,fee schedule,145% of CMS fee schedule,30.44,145,,,fee schedule,145% of CMS fee schedule,30.44,145,,,fee schedule,145% of CMS fee schedule,30.44,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46,40,,36.8,percent of total billed charges,40% of total billed charges,30.44,92,
MAMMO UNIL SCR W/CAD,6001835,CDM,403,RC,77067,HCPCS,Outpatient,,,393,314.40,26,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.4,80,,251.52,percent of total billed charges,80% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% of total billed charges,117.25,145,,,fee schedule,145% of CMS fee schedule,117.25,145,,,fee schedule,145% of CMS fee schedule,117.25,145,,,fee schedule,145% of CMS fee schedule,117.25,145,,,fee schedule,145% of CMS fee schedule,117.25,145,,,fee schedule,145% of CMS fee schedule,117.25,145,,,fee schedule,145% of CMS fee schedule,117.25,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.2,40,,125.76,percent of total billed charges,40% of total billed charges,117.25,314.4,
COGNITIVE FUNCT 1ST,6739429,CDM,440,RC,97129,HCPCS,Outpatient,,,75,60.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,80,,48,percent of total billed charges,80% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% of total billed charges,31.02,145,,,fee schedule,145% of CMS fee schedule,31.02,145,,,fee schedule,145% of CMS fee schedule,31.02,145,,,fee schedule,145% of CMS fee schedule,31.02,145,,,fee schedule,145% of CMS fee schedule,31.02,145,,,fee schedule,145% of CMS fee schedule,31.02,145,,,fee schedule,145% of CMS fee schedule,31.02,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,40,,24,percent of total billed charges,40% of total billed charges,27.95,60,
COGNITIVE FUNCT ADD,6739429,CDM,440,RC,97130,HCPCS,Outpatient,,,65,52.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% of total billed charges,29.64,145,,,fee schedule,145% of CMS fee schedule,29.64,145,,,fee schedule,145% of CMS fee schedule,29.64,145,,,fee schedule,145% of CMS fee schedule,29.64,145,,,fee schedule,145% of CMS fee schedule,29.64,145,,,fee schedule,145% of CMS fee schedule,29.64,145,,,fee schedule,145% of CMS fee schedule,29.64,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26,40,,20.8,percent of total billed charges,40% of total billed charges,24.23,52,
ST ESTIM ATTEN 15M,6739429,CDM,440,RC,97032,HCPCS,Outpatient,,,80,64.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,19.79,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,40,,25.6,percent of total billed charges,40% of total billed charges,19.79,64,
PT HOME ADL EA 15M,6610133,CDM,420,RC,97535,HCPCS,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,44.25,145,,,fee schedule,145% of CMS fee schedule,44.25,145,,,fee schedule,145% of CMS fee schedule,44.25,145,,,fee schedule,145% of CMS fee schedule,44.25,145,,,fee schedule,145% of CMS fee schedule,44.25,145,,,fee schedule,145% of CMS fee schedule,44.25,145,,,fee schedule,145% of CMS fee schedule,44.25,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,62.4,
STAND COGNIT ASSESS,6739445,CDM,444,RC,96125,HCPCS,Outpatient,,,300,240.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,140.75,145,,,fee schedule,145% of CMS fee schedule,140.75,145,,,fee schedule,145% of CMS fee schedule,140.75,145,,,fee schedule,145% of CMS fee schedule,140.75,145,,,fee schedule,145% of CMS fee schedule,140.75,145,,,fee schedule,145% of CMS fee schedule,140.75,145,,,fee schedule,145% of CMS fee schedule,140.75,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,111.81,240,
ORTH/PROS SUBSQ ENC,6610133,CDM,420,RC,97763,HCPCS,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,69.38,145,,,fee schedule,145% of CMS fee schedule,69.38,145,,,fee schedule,145% of CMS fee schedule,69.38,145,,,fee schedule,145% of CMS fee schedule,69.38,145,,,fee schedule,145% of CMS fee schedule,69.38,145,,,fee schedule,145% of CMS fee schedule,69.38,145,,,fee schedule,145% of CMS fee schedule,69.38,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34,40,,27.2,percent of total billed charges,40% of total billed charges,31.68,69.38,
ORTH/PROS SUBSQ ENC,6610133,CDM,420,RC,97763,HCPCS,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,69.38,145,,,fee schedule,145% of CMS fee schedule,69.38,145,,,fee schedule,145% of CMS fee schedule,69.38,145,,,fee schedule,145% of CMS fee schedule,69.38,145,,,fee schedule,145% of CMS fee schedule,69.38,145,,,fee schedule,145% of CMS fee schedule,69.38,145,,,fee schedule,145% of CMS fee schedule,69.38,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34,40,,27.2,percent of total billed charges,40% of total billed charges,31.68,69.38,
OT MANUL THER 30M,6510135,CDM,430,RC,97140,HCPCS,Outpatient,,,156,124.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,40,,49.92,percent of total billed charges,40% of total billed charges,36.95,124.8,
OT MANUL THER EA 45M,6510135,CDM,430,RC,97140,HCPCS,Outpatient,,,234,187.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.2,80,,149.76,percent of total billed charges,80% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,36.95,187.2,
OT THER ACT EA 30M,6510135,CDM,430,RC,97530,HCPCS,Outpatient,,,224,179.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.2,80,,143.36,percent of total billed charges,80% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% of total billed charges,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,40,,71.68,percent of total billed charges,40% of total billed charges,49.27,179.2,
OT THER ACT EA 45M,6510135,CDM,430,RC,97530,HCPCS,Outpatient,,,336,268.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268.8,80,,215.04,percent of total billed charges,80% of total billed charges,125.23,37.27,,100.18,percent of total billed charges,37.27% of total billed charges,125.23,37.27,,100.18,percent of total billed charges,37.27% of total billed charges,125.23,37.27,,100.18,percent of total billed charges,37.27% of total billed charges,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.4,40,,107.52,percent of total billed charges,40% of total billed charges,49.27,268.8,
OT THER EXER EA 30M,6510135,CDM,430,RC,97110,HCPCS,Outpatient,,,238,190.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.4,80,,152.32,percent of total billed charges,80% of total billed charges,88.7,37.27,,70.96,percent of total billed charges,37.27% of total billed charges,88.7,37.27,,70.96,percent of total billed charges,37.27% of total billed charges,88.7,37.27,,70.96,percent of total billed charges,37.27% of total billed charges,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.2,40,,76.16,percent of total billed charges,40% of total billed charges,40.02,190.4,
OT THER EXER EA 45,6510135,CDM,430,RC,97110,HCPCS,Outpatient,,,357,285.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,285.6,80,,228.48,percent of total billed charges,80% of total billed charges,133.05,37.27,,106.44,percent of total billed charges,37.27% of total billed charges,133.05,37.27,,106.44,percent of total billed charges,37.27% of total billed charges,133.05,37.27,,106.44,percent of total billed charges,37.27% of total billed charges,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.8,40,,114.24,percent of total billed charges,40% of total billed charges,40.02,285.6,
PT MANUAL THER EA 30,6610133,CDM,420,RC,97140,HCPCS,Outpatient,,,156,124.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,40,,49.92,percent of total billed charges,40% of total billed charges,36.95,124.8,
PT MANUAL THER EA 45,6610133,CDM,420,RC,97140,HCPCS,Outpatient,,,234,187.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.2,80,,149.76,percent of total billed charges,80% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,36.95,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,36.95,187.2,
PT THER ACT EA 30M,6610133,CDM,420,RC,97530,HCPCS,Outpatient,,,156,124.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,40,,49.92,percent of total billed charges,40% of total billed charges,49.27,124.8,
PT THER ACT EA 45M,6610133,CDM,420,RC,97530,HCPCS,Outpatient,,,234,187.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.2,80,,149.76,percent of total billed charges,80% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,49.27,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,49.27,187.2,
PT THER EX EA 30M,6610133,CDM,420,RC,97110,HCPCS,Outpatient,,,156,124.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,40,,49.92,percent of total billed charges,40% of total billed charges,40.02,124.8,
PT THER EX EA 45M,6610133,CDM,420,RC,97110,HCPCS,Outpatient,,,234,187.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.2,80,,149.76,percent of total billed charges,80% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,40.02,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,40.02,187.2,
FEES EVAL,6739445,CDM,444,RC,92612,HCPCS,Outpatient,,,245,196.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196,80,,156.8,percent of total billed charges,80% of total billed charges,91.31,37.27,,73.05,percent of total billed charges,37.27% of total billed charges,91.31,37.27,,73.05,percent of total billed charges,37.27% of total billed charges,91.31,37.27,,73.05,percent of total billed charges,37.27% of total billed charges,91.67,145,,,fee schedule,145% of CMS fee schedule,91.67,145,,,fee schedule,145% of CMS fee schedule,91.67,145,,,fee schedule,145% of CMS fee schedule,91.67,145,,,fee schedule,145% of CMS fee schedule,91.67,145,,,fee schedule,145% of CMS fee schedule,91.67,145,,,fee schedule,145% of CMS fee schedule,91.67,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98,40,,78.4,percent of total billed charges,40% of total billed charges,91.31,196,
2ND FLOOR PRIVATE,13003,CDM,110,RC,,,Inpatient,,,778,622.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,622.4,80,,497.92,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,622.4,622.4,
OB PRIVATE ROOM,14001,CDM,112,RC,,,Inpatient,,,1049,839.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,839.2,80,,671.36,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,839.2,839.2,
2ND FLOOR SEMI PVT,23002,CDM,120,RC,,,Inpatient,,,185,148.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148,80,,118.4,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,148,148,
ICU,12005,CDM,200,RC,,,Inpatient,,,1946,1556.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1556.8,80,,1245.44,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,1556.8,1556.8,
NURSERY,55004,CDM,170,RC,,,Inpatient,,,408,326.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,326.4,80,,261.12,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,326.4,326.4,
HOPE PRIVATE,71001,CDM,114,RC,,,Inpatient,,,2100,1680.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1680,80,,1344,percent of total billed charges,80% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,900,100,,,per diem,pays based on per day rate,900,100,,,per diem,pays based on per day rate,900,100,,,per diem,pays based on per day rate,900,145,,,fee schedule,145% of CMS fee schedule,900,100,,,per diem,pays based on per day rate,900,100,,,per diem,pays based on per day rate,900,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,900,1680,
SWING BED ROOM,13003,CDM,110,RC,,,Inpatient,,,973,778.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,778.4,80,,622.72,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,778.4,778.4,
IND DIAB TRNG PER 30,4418307,CDM,942,RC,98960,HCPCS,Outpatient,,,54,43.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,20.13,37.27,,16.1,percent of total billed charges,37.27% of total billed charges,20.13,37.27,,16.1,percent of total billed charges,37.27% of total billed charges,20.13,37.27,,16.1,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.15,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,40,,17.28,percent of total billed charges,40% of total billed charges,20.13,43.2,
OSS EST PAT LEVEL 3,5612346,CDM,761,RC,99213,HCPCS,Outpatient,,,219,175.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.2,80,,140.16,percent of total billed charges,80% of total billed charges,81.62,37.27,,65.3,percent of total billed charges,37.27% of total billed charges,81.62,37.27,,65.3,percent of total billed charges,37.27% of total billed charges,81.62,37.27,,65.3,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.94,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.6,40,,70.08,percent of total billed charges,40% of total billed charges,81.62,175.2,
OSS EST PAT LEVEL 1,5617243,CDM,940,RC,99211,HCPCS,Outpatient,,,146,116.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.19,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,12.19,116.8,
OSS EST PAT LEVEL 2,5612346,CDM,761,RC,99212,HCPCS,Outpatient,,,210,168.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168,80,,134.4,percent of total billed charges,80% of total billed charges,78.27,37.27,,62.62,percent of total billed charges,37.27% of total billed charges,78.27,37.27,,62.62,percent of total billed charges,37.27% of total billed charges,78.27,37.27,,62.62,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.36,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,40,,67.2,percent of total billed charges,40% of total billed charges,49.36,168,
OSS EST PAT LEVEL 4,5612346,CDM,761,RC,99214,HCPCS,Outpatient,,,279,223.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,103.98,37.27,,83.18,percent of total billed charges,37.27% of total billed charges,103.98,37.27,,83.18,percent of total billed charges,37.27% of total billed charges,103.98,37.27,,83.18,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.49,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.6,40,,89.28,percent of total billed charges,40% of total billed charges,103.98,223.2,
OSS EST PAT LEVEL 5,5612346,CDM,761,RC,99215,HCPCS,Outpatient,,,360,288.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,134.17,37.27,,107.34,percent of total billed charges,37.27% of total billed charges,134.17,37.27,,107.34,percent of total billed charges,37.27% of total billed charges,134.17,37.27,,107.34,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.98,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,40,,115.2,percent of total billed charges,40% of total billed charges,134.17,288,
IV CANNULA NEEDLELES,5645742,CDM,270,RC,,,Outpatient,,,1,0.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,80,,0.64,percent of total billed charges,80% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% 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,0.4,40,,0.32,percent of total billed charges,40% of total billed charges,0.37,0.8,
IV Y TYPE MICRO EXT,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
IV D10S 1000CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D10W 1000CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D10W 500CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D5 45NS 1000CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D5 45NS 500CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D5 2% SOD CH 500,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D5RL 1000CC,5753355,CDM,258,RC,J7121,HCPCS,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D5RL 500CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D5NS 1000CC,5753355,CDM,258,RC,J7042,HCPCS,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D5NS 500CC,5753355,CDM,258,RC,J7042,HCPCS,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D5W 100CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D5W 250CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D5W 500CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D5W 1000CC,5753355,CDM,258,RC,J7070,HCPCS,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D5W 250CC GLASS B,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D5 2% SOD CH 1000,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV DEXTROSE 5% 0.4%,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV LR 1000CC,5753355,CDM,258,RC,J7120,HCPCS,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV LR 500CC,5753355,CDM,258,RC,J7120,HCPCS,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV NS 100CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV NS 250CC,5753355,CDM,258,RC,J7050,HCPCS,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV NS 500CC,5753355,CDM,258,RC,J7040,HCPCS,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV NS 1000CC,5753355,CDM,258,RC,J7030,HCPCS,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV NS 5% 500CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV RINGERS 1000CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV SOD CHL 0.45% 100,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV SOD CHL 3% IN WAT,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
SAF CLENS WOUND CLNS,5645742,CDM,270,RC,,,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% 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,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,8.94,19.2,
DRSING ALGSTE 4X4,5645742,CDM,270,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
AQCL HYDRFBR PACKING,5645742,CDM,270,RC,,,Outpatient,,,23,18.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% 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,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,8.57,18.4,
DRSING ALGSTE 3/4X12,5645742,CDM,270,RC,,,Outpatient,,,19,15.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% 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,7.6,40,,6.08,percent of total billed charges,40% of total billed charges,7.08,15.2,
HYDROSORB DRESSING 4,5645742,CDM,270,RC,,,Outpatient,,,4,3.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
ALOE VESTA ANIFUGAL,5645742,CDM,270,RC,,,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
ALOE VESTA PERINAL S,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
ALOE VESTA OINTMENT,5645742,CDM,270,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
DRESSING HYPA 2X10,5801832,CDM,272,RC,,,Outpatient,,,37,29.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% 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,14.8,40,,11.84,percent of total billed charges,40% of total billed charges,13.79,29.6,
DRESSING HYPA 4X10,5801832,CDM,272,RC,,,Outpatient,,,63,50.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% 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,25.2,40,,20.16,percent of total billed charges,40% of total billed charges,23.48,50.4,
DRESSING AIRSTRIP 10,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
CORD CLAMP CLIPPER,5645742,CDM,270,RC,,,Outpatient,,,26,20.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% 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,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,9.69,20.8,
GU BAG & TUBE SMALL,5645742,CDM,270,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
GU BAG LEG TYPE,5645742,CDM,270,RC,,,Outpatient,,,19,15.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% 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,7.6,40,,6.08,percent of total billed charges,40% of total billed charges,7.08,15.2,
GU WATER 1000CC,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
GU BAG & TUBE LARGE,5645742,CDM,270,RC,,,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
SUTURE CS-482 SOFSIL,5801832,CDM,272,RC,,,Outpatient,,,21,16.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% 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,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,7.83,16.8,
DRESSING ALLEVYN 7X7,5801832,CDM,272,RC,,,Outpatient,,,38,30.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% 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,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,14.16,30.4,
DRESSING ALLEVYN 3X3,5801832,CDM,272,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
DVT COMPRSN PUMP DAY,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
MEDSURG BLOOD TRANSF,5811120,CDM,391,RC,36430,HCPCS,Outpatient,,,1034,827.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,827.2,80,,661.76,percent of total billed charges,80% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,54.09,145,,,fee schedule,145% of CMS fee schedule,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413.6,40,,330.88,percent of total billed charges,40% of total billed charges,54.09,827.2,
MOLESKIN,5645742,CDM,270,RC,,,Outpatient,,,2,1.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
SUTURE CG982,5801832,CDM,272,RC,,,Outpatient,,,23,18.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% 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,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,8.57,18.4,
ELECTRONE QUICK CONN,5645742,CDM,270,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
GLOVES BIOGEL SURG,5645742,CDM,270,RC,,,Outpatient,,,16,12.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% 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,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,5.96,12.8,
SUTURE J415,5801832,CDM,272,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
CIRCUMCISION,8400010,CDM,760,RC,54150,HCPCS,Outpatient,,,3055,2444.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2444,80,,1955.2,percent of total billed charges,80% of total billed charges,1138.6,37.27,,910.88,percent of total billed charges,37.27% of total billed charges,1138.6,37.27,,910.88,percent of total billed charges,37.27% of total billed charges,1138.6,37.27,,910.88,percent of total billed charges,37.27% of total billed charges,1679.37,100,,,fee schedule,100% of APC rate,1679.37,100,,,fee schedule,100% of APC rate,1679.37,100,,,fee schedule,100% of APC rate,134.97,145,,,fee schedule,145% of CMS fee schedule,1679.37,100,,,fee schedule,100% of APC rate,1679.37,100,,,fee schedule,100% of APC rate,1679.37,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1222,40,,977.6,percent of total billed charges,40% of total billed charges,134.97,2444,
FILTER GOMCO 6000,5645742,CDM,270,RC,,,Outpatient,,,26,20.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% 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,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,9.69,20.8,
TUBING SUCTION GOMCO,5645742,CDM,270,RC,,,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% 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,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,27.21,58.4,
CANN SUC GOMCO 6000,5645742,CDM,270,RC,,,Outpatient,,,42,33.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% 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,16.8,40,,13.44,percent of total billed charges,40% of total billed charges,15.65,33.6,
FILTER PALL EZ PRIME,5645742,CDM,270,RC,,,Outpatient,,,67,53.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% 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,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,24.97,53.6,
INFANT SHIRTS,5828504,CDM,990,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
SLIPPER,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
PULSE OX SENSOR,5645742,CDM,270,RC,,,Outpatient,,,82,65.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,30.56,37.27,,24.45,percent of total billed charges,37.27% of total billed charges,30.56,37.27,,24.45,percent of total billed charges,37.27% of total billed charges,30.56,37.27,,24.45,percent of total billed charges,37.27% 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,32.8,40,,26.24,percent of total billed charges,40% of total billed charges,30.56,65.6,
TAPE CO WRAP,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
BOTTLE PLAYTEX NURSE,5828504,CDM,990,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
STOPCOCK MANNIFOLD,5645742,CDM,270,RC,,,Outpatient,,,51,40.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,19.01,37.27,,15.21,percent of total billed charges,37.27% of total billed charges,19.01,37.27,,15.21,percent of total billed charges,37.27% of total billed charges,19.01,37.27,,15.21,percent of total billed charges,37.27% 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,20.4,40,,16.32,percent of total billed charges,40% of total billed charges,19.01,40.8,
BRIEF STRETCH LARGE,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
COLD PACK,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
ENDOTRACHEAL TUBE NE,5645742,CDM,270,RC,,,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% 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,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,10.44,22.4,
TRAY DRESSING CENTRA,5645742,CDM,270,RC,,,Outpatient,,,42,33.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% 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,16.8,40,,13.44,percent of total billed charges,40% of total billed charges,15.65,33.6,
MASK AIR CUSH NEO,5645742,CDM,270,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
BINDER ABD LG-XL,5645742,CDM,270,RC,,,Outpatient,,,53,42.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% 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,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,19.75,42.4,
IV PERI 2-LUMEN,5645742,CDM,270,RC,,,Outpatient,,,31,24.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% 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,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,11.55,24.8,
BANDAGE ACE 2,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
BANDAGE ACE 3,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
BANDAGE ACE 4,5645742,CDM,270,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
BANDAGE ACE 6 INCH,5645742,CDM,270,RC,,,Outpatient,,,26,20.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% 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,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,9.69,20.8,
ADAPTIC 3X3,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
ADAPTIC 3X8,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
AIRWAY ADULT SZ 3-5,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
AIRWAY NASAL,5645742,CDM,270,RC,,,Outpatient,,,77,61.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% 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,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,28.7,61.6,
AMNIHOOK,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
LANCET FINGER DEVICE,5645742,CDM,270,RC,,,Outpatient,,,1,0.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,80,,0.64,percent of total billed charges,80% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% 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,0.4,40,,0.32,percent of total billed charges,40% of total billed charges,0.37,0.8,
COMBISTIX,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
ART CANNULATION SUPP,5645742,CDM,270,RC,,,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% 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,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,14.54,31.2,
ARTERY CATH SET RDL,5645742,CDM,270,RC,,,Outpatient,,,42,33.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% 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,16.8,40,,13.44,percent of total billed charges,40% of total billed charges,15.65,33.6,
ARTERIAL LINE KIT,5645742,CDM,270,RC,,,Outpatient,,,80,64.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% 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,32,40,,25.6,percent of total billed charges,40% of total billed charges,29.82,64,
IV D5W 500ML LATEX F,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
BOTTLE BABY W NIPPLE,5828504,CDM,990,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV FILTER .2 MICRON,5645742,CDM,270,RC,,,Outpatient,,,41,32.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% 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,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,15.28,32.8,
BARRIER TOWEL STERIL,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
MASK BILI,5645742,CDM,270,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
TOOTHETTES,5828504,CDM,990,RC,,,Outpatient,,,1,0.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,80,,0.64,percent of total billed charges,80% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% 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,0.4,40,,0.32,percent of total billed charges,40% of total billed charges,0.37,0.8,
BITES JAWLOCK,5645742,CDM,270,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
BLADE W SURGICAL CLI,5801832,CDM,272,RC,,,Outpatient,,,26,20.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% 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,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,9.69,20.8,
BLADE KNIFE,5801832,CDM,272,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
BLOOD PRESSURE CUFF,5645742,CDM,270,RC,,,Outpatient,,,97,77.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% 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,38.8,40,,31.04,percent of total billed charges,40% of total billed charges,36.15,77.6,
BLOOD WARMER,5645742,CDM,270,RC,,,Outpatient,,,63,50.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% 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,25.2,40,,20.16,percent of total billed charges,40% of total billed charges,23.48,50.4,
FILTER BLD TRANSFUSI,5645742,CDM,270,RC,,,Outpatient,,,22,17.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% 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,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,8.2,17.6,
BONE MARROW ILN TRAY,5801832,CDM,272,RC,,,Outpatient,,,186,148.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% 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,74.4,40,,59.52,percent of total billed charges,40% of total billed charges,69.32,148.8,
BONE MARROW JAM TRAY,5801832,CDM,272,RC,,,Outpatient,,,136,108.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% 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,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,50.69,108.8,
BOTTLE PERI WASH TYP,5828504,CDM,990,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
SPECIMEN TRAP BRONC,5645742,CDM,270,RC,,,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
BULKY BANDAGE,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
BAG HYPER INFLATION,5645742,CDM,270,RC,,,Outpatient,,,40,32.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% 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,16,40,,12.8,percent of total billed charges,40% of total billed charges,14.91,32,
BREAST NURSING PADS,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
HEPA-CARE DAILY,5645742,CDM,270,RC,,,Outpatient,,,55,44.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% 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,22,40,,17.6,percent of total billed charges,40% of total billed charges,20.5,44,
BREAST PUMP KIT,5645742,CDM,270,RC,,,Outpatient,,,154,123.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.2,80,,98.56,percent of total billed charges,80% of total billed charges,57.4,37.27,,45.92,percent of total billed charges,37.27% of total billed charges,57.4,37.27,,45.92,percent of total billed charges,37.27% of total billed charges,57.4,37.27,,45.92,percent of total billed charges,37.27% 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,61.6,40,,49.28,percent of total billed charges,40% of total billed charges,57.4,123.2,
CANNULA INNER DISP,5645742,CDM,270,RC,,,Outpatient,,,23,18.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% 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,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,8.57,18.4,
CANNULA INNER SZ9,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
PERCU TRACH SET,5645742,CDM,270,RC,,,Outpatient,,,993,794.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,794.4,80,,635.52,percent of total billed charges,80% of total billed charges,370.09,37.27,,296.07,percent of total billed charges,37.27% of total billed charges,370.09,37.27,,296.07,percent of total billed charges,37.27% of total billed charges,370.09,37.27,,296.07,percent of total billed charges,37.27% 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,397.2,40,,317.76,percent of total billed charges,40% of total billed charges,370.09,794.4,
CATH PRE CON 16F-18F,5645742,CDM,270,RC,,,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% 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,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,14.54,31.2,
CATH FOLEY 12F-16F,5645742,CDM,270,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
CATH KIT FEMALE,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
CATH NOZ STOP,5645742,CDM,270,RC,,,Outpatient,,,94,75.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% 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,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,35.03,75.2,
CATH PLUG,5645742,CDM,270,RC,,,Outpatient,,,2,1.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
CATH RED RUBBER,5645742,CDM,270,RC,,,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
CATH FOLEY SILICONE,5645742,CDM,270,RC,,,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% 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,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,10.06,21.6,
CATH STRAP SZ MED,5645742,CDM,270,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
CENTRAL LINE CATHETR,5801832,CDM,272,RC,C1751,HCPCS,Outpatient,,,31,24.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% 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,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,11.55,24.8,
CATH SUCTION,5645742,CDM,270,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
CATH SUGGS SZ 24,5645742,CDM,270,RC,,,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% 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,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,27.21,58.4,
CATH TEXAS,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
CATH THORACIC 28FR,5645742,CDM,270,RC,,,Outpatient,,,35,28.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28,80,,22.4,percent of total billed charges,80% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% 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,14,40,,11.2,percent of total billed charges,40% of total billed charges,13.04,28,
CATH THORACIC,5645742,CDM,270,RC,,,Outpatient,,,95,76.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% 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,38,40,,30.4,percent of total billed charges,40% of total billed charges,35.41,76,
CATH TRAY REG,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
CATH TRAY W/O CATH,5645742,CDM,270,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
CATH TRI LUMEN 7FR,5801832,CDM,272,RC,,,Outpatient,,,242,193.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.6,80,,154.88,percent of total billed charges,80% of total billed charges,90.19,37.27,,72.15,percent of total billed charges,37.27% of total billed charges,90.19,37.27,,72.15,percent of total billed charges,37.27% of total billed charges,90.19,37.27,,72.15,percent of total billed charges,37.27% 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,96.8,40,,77.44,percent of total billed charges,40% of total billed charges,90.19,193.6,
PERCU SHEATH INTRO,5801832,CDM,272,RC,C1894,HCPCS,Outpatient,,,149,119.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% 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,59.6,40,,47.68,percent of total billed charges,40% of total billed charges,55.53,119.2,
CATH TRI-LUMEN 20CM,5645742,CDM,270,RC,,,Outpatient,,,235,188.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188,80,,150.4,percent of total billed charges,80% of total billed charges,87.58,37.27,,70.06,percent of total billed charges,37.27% of total billed charges,87.58,37.27,,70.06,percent of total billed charges,37.27% of total billed charges,87.58,37.27,,70.06,percent of total billed charges,37.27% 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,94,40,,75.2,percent of total billed charges,40% of total billed charges,87.58,188,
CATH TROCAR 28FR,5645742,CDM,270,RC,,,Outpatient,,,118,94.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% 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,47.2,40,,37.76,percent of total billed charges,40% of total billed charges,43.98,94.4,
CATH URETERAL ADPTR,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
COLO WAFER 1 3/4,5645742,CDM,270,RC,,,Outpatient,,,47,37.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% 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,18.8,40,,15.04,percent of total billed charges,40% of total billed charges,17.52,37.6,
COLO DRAIN PCH 1 3/4,5645742,CDM,270,RC,,,Outpatient,,,53,42.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.4,80,,33.92,percent of total billed charges,80% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% of total billed charges,19.75,37.27,,15.8,percent of total billed charges,37.27% 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,21.2,40,,16.96,percent of total billed charges,40% of total billed charges,19.75,42.4,
CIRCUM DEV PLASTIBEL,5645742,CDM,270,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
CLAVICLE STRAP LG,5645742,CDM,270,RC,,,Outpatient,,,43,34.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% 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,17.2,40,,13.76,percent of total billed charges,40% of total billed charges,16.03,34.4,
COLO IRRIGATOR VISIF,5645742,CDM,270,RC,,,Outpatient,,,71,56.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% 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,28.4,40,,22.72,percent of total billed charges,40% of total billed charges,26.46,56.8,
COLO DRAIN PCH 2 3/4,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
COLO IRR SLV 2 3/4,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
COLO IRR WAFER 2 3/4,5645742,CDM,270,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
COLO IRR DRAIN POUCH,5645742,CDM,270,RC,,,Outpatient,,,65,52.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% 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,26,40,,20.8,percent of total billed charges,40% of total billed charges,24.23,52,
COLO WAFER 2 3/4 AUT,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
CORD CLAMP,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
CATH COUDE FOLEY,5645742,CDM,270,RC,,,Outpatient,,,59,47.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% 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,23.6,40,,18.88,percent of total billed charges,40% of total billed charges,21.99,47.2,
CATH TROCAR KIT,5645742,CDM,270,RC,,,Outpatient,,,162,129.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% 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,64.8,40,,51.84,percent of total billed charges,40% of total billed charges,60.38,129.6,
CUP DENTURE,5828504,CDM,990,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
CYSTO IRRIGATION SET,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
DEBRIDEMENT TRAY,5645742,CDM,270,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
PAD DERMA CARE,5645742,CDM,270,RC,,,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% 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,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,27.21,58.4,
DEXTROSTIX,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
DIAPER ADULT,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
WATER DISTILLED 1000,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
DOBBHOFF FEEDNG TUBE,5645742,CDM,270,RC,,,Outpatient,,,47,37.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% 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,18.8,40,,15.04,percent of total billed charges,40% of total billed charges,17.52,37.6,
SPONGE DRAIN,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
BONE MARROW ASP SET,5801832,CDM,272,RC,,,Outpatient,,,37,29.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% 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,14.8,40,,11.84,percent of total billed charges,40% of total billed charges,13.79,29.6,
SPEC VAG DISP SM-LG,5645742,CDM,270,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
ELECTRODE QUICK COMB,5645742,CDM,270,RC,,,Outpatient,,,107,85.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,39.88,37.27,,31.9,percent of total billed charges,37.27% of total billed charges,39.88,37.27,,31.9,percent of total billed charges,37.27% of total billed charges,39.88,37.27,,31.9,percent of total billed charges,37.27% 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,42.8,40,,34.24,percent of total billed charges,40% of total billed charges,39.88,85.6,
ELECTRO POLY PEDI E7,5645742,CDM,270,RC,,,Outpatient,,,40,32.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% 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,16,40,,12.8,percent of total billed charges,40% of total billed charges,14.91,32,
ENEMA TRAY,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
EPIDURAL INFUSER 5ML,5645742,CDM,270,RC,,,Outpatient,,,136,108.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% 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,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,50.69,108.8,
EYE PAD,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
BAG FEEDING FLEXI EN,5645742,CDM,270,RC,,,Outpatient,,,16,12.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% 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,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,5.96,12.8,
FILTER URINE,5645742,CDM,270,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
GELOCAST,5645742,CDM,270,RC,,,Outpatient,,,40,32.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% 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,16,40,,12.8,percent of total billed charges,40% of total billed charges,14.91,32,
GLOVES SURG,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
GLYCINE 3000CC,5645742,CDM,270,RC,,,Outpatient,,,31,24.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% 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,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,11.55,24.8,
GOWN SURG STERILE,5645742,CDM,270,RC,,,Outpatient,,,16,12.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% 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,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,5.96,12.8,
TUBE TRACH 6 DCFS,5645742,CDM,270,RC,,,Outpatient,,,172,137.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.6,80,,110.08,percent of total billed charges,80% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% of total billed charges,64.1,37.27,,51.28,percent of total billed charges,37.27% 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,68.8,40,,55.04,percent of total billed charges,40% of total billed charges,64.1,137.6,
PAD HEEL PROTECTION,5645742,CDM,270,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
HEELBO,5645742,CDM,270,RC,,,Outpatient,,,93,74.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% 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,37.2,40,,29.76,percent of total billed charges,40% of total billed charges,34.66,74.4,
HYPO BLANKET 24X60,5645742,CDM,270,RC,,,Outpatient,,,221,176.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,82.37,37.27,,65.9,percent of total billed charges,37.27% of total billed charges,82.37,37.27,,65.9,percent of total billed charges,37.27% of total billed charges,82.37,37.27,,65.9,percent of total billed charges,37.27% 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,88.4,40,,70.72,percent of total billed charges,40% of total billed charges,82.37,176.8,
ICE PACK LG CONSTANT,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
IMMOBILIZER KNE S-XL,5645742,CDM,270,RC,,,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% 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,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,27.21,58.4,
INCISION & DRNAGE TR,5645742,CDM,270,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
BALECTRODE PACING KI,5645742,CDM,270,RC,,,Outpatient,,,356,284.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,284.8,80,,227.84,percent of total billed charges,80% of total billed charges,132.68,37.27,,106.14,percent of total billed charges,37.27% of total billed charges,132.68,37.27,,106.14,percent of total billed charges,37.27% of total billed charges,132.68,37.27,,106.14,percent of total billed charges,37.27% 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,142.4,40,,113.92,percent of total billed charges,40% of total billed charges,132.68,284.8,
CATH INTRA UTERINE P,5645742,CDM,270,RC,,,Outpatient,,,83,66.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% 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,33.2,40,,26.56,percent of total billed charges,40% of total billed charges,30.93,66.4,
RING INVALID FOAM,5828504,CDM,990,RC,,,Outpatient,,,59,47.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% 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,23.6,40,,18.88,percent of total billed charges,40% of total billed charges,21.99,47.2,
IRRIGATION TRAY,5645742,CDM,270,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
TEETH EXCISION,5645742,CDM,270,RC,,,Outpatient,,,61,48.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% 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,24.4,40,,19.52,percent of total billed charges,40% of total billed charges,22.73,48.8,
COLO PASTE,5645742,CDM,270,RC,,,Outpatient,,,36,28.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% 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,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,13.42,28.8,
KY JELLY 4 OZ,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
KY JELLY SYRINGES,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
KEITH VALVE,5645742,CDM,270,RC,,,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% 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,10,40,,8,percent of total billed charges,40% of total billed charges,9.32,20,
KY JELLY 5GM STERILE,5645742,CDM,270,RC,,,Outpatient,,,2,1.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
KLING 2,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
KLING 3,5645742,CDM,270,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
KLING 4,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
KLING 6,5645742,CDM,270,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
DRESSING XERO FORM 5,5801832,CDM,272,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
Y-TYPE TUR SET,5645742,CDM,270,RC,,,Outpatient,,,35,28.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28,80,,22.4,percent of total billed charges,80% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% 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,14,40,,11.2,percent of total billed charges,40% of total billed charges,13.04,28,
YANKAUER SUCTION TIP,5645742,CDM,270,RC,,,Outpatient,,,4,3.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
CATH FOLEY 3-WAY,5645742,CDM,270,RC,,,Outpatient,,,42,33.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% 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,16.8,40,,13.44,percent of total billed charges,40% of total billed charges,15.65,33.6,
PCA TUBING SET 101,5645742,CDM,270,RC,,,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% 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,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,18.26,39.2,
CATH COUNCIL,5645742,CDM,270,RC,,,Outpatient,,,68,54.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% 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,27.2,40,,21.76,percent of total billed charges,40% of total billed charges,25.34,54.4,
DUODERM,5801832,CDM,272,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
TRAY LUMBAR PUNC INF,5645742,CDM,270,RC,,,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% 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,28,40,,22.4,percent of total billed charges,40% of total billed charges,26.09,56,
MEDICREME,5880901,CDM,637,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
MONITOR CARD BP SA02,5645742,CDM,270,RC,,,Outpatient,,,406,324.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,324.8,80,,259.84,percent of total billed charges,80% of total billed charges,151.32,37.27,,121.06,percent of total billed charges,37.27% of total billed charges,151.32,37.27,,121.06,percent of total billed charges,37.27% of total billed charges,151.32,37.27,,121.06,percent of total billed charges,37.27% 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,162.4,40,,129.92,percent of total billed charges,40% of total billed charges,151.32,324.8,
MONTGOMERY STRAPS,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
MUCUS TRAP INFANT VY,5645742,CDM,270,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
NEEDLE ADM WY 22X1,5645742,CDM,270,RC,,,Outpatient,,,59,47.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% 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,23.6,40,,18.88,percent of total billed charges,40% of total billed charges,21.99,47.2,
NEEDLE ADM WY 22X3/4,5645742,CDM,270,RC,,,Outpatient,,,59,47.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% 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,23.6,40,,18.88,percent of total billed charges,40% of total billed charges,21.99,47.2,
NEEDLE ADMIN 20 X 1,5645742,CDM,270,RC,,,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% 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,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,8.94,19.2,
NEEDLE SPINAL18X3 1/,5645742,CDM,270,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
NIPPLE NUK NURSERY,5645742,CDM,270,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
NIPPLES BABY PREMATU,5828504,CDM,990,RC,,,Outpatient,,,1,0.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,80,,0.64,percent of total billed charges,80% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% 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,0.4,40,,0.32,percent of total billed charges,40% of total billed charges,0.37,0.8,
NIPPLE SHIELD MEDELA,5645742,CDM,270,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
NIPPLES BABY REGULAR,5828504,CDM,990,RC,,,Outpatient,,,1,0.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,80,,0.64,percent of total billed charges,80% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% 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,0.4,40,,0.32,percent of total billed charges,40% of total billed charges,0.37,0.8,
NU GAUZE PLAIN 1/4-1,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
OCT TEST,5645742,CDM,270,RC,,,Outpatient,,,89,71.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,33.17,37.27,,26.54,percent of total billed charges,37.27% of total billed charges,33.17,37.27,,26.54,percent of total billed charges,37.27% of total billed charges,33.17,37.27,,26.54,percent of total billed charges,37.27% 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,35.6,40,,28.48,percent of total billed charges,40% of total billed charges,33.17,71.2,
OP SITE 2X3,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
OP SITE 5 1/2X 4,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
PACIFIER NUK,5828504,CDM,990,RC,,,Outpatient,,,4,3.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
PAD DUO THERM 14X20,5645742,CDM,270,RC,,,Outpatient,,,71,56.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% 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,28.4,40,,22.72,percent of total billed charges,40% of total billed charges,26.46,56.8,
PERINEAL CARE,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
STETHOSCOPE DISP,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
PNEUMOTHORAX KIT,5645742,CDM,270,RC,,,Outpatient,,,336,268.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268.8,80,,215.04,percent of total billed charges,80% of total billed charges,125.23,37.27,,100.18,percent of total billed charges,37.27% of total billed charges,125.23,37.27,,100.18,percent of total billed charges,37.27% of total billed charges,125.23,37.27,,100.18,percent of total billed charges,37.27% 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,134.4,40,,107.52,percent of total billed charges,40% of total billed charges,125.23,268.8,
INFUSER PRESSURE DIS,5645742,CDM,270,RC,,,Outpatient,,,63,50.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% 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,25.2,40,,20.16,percent of total billed charges,40% of total billed charges,23.48,50.4,
PROBE DISPOSABLE,5645742,CDM,270,RC,,,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% 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,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,14.54,31.2,
NON-STRESS TEST,8400010,CDM,760,RC,59025,HCPCS,Outpatient,,,440,352.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352,80,,281.6,percent of total billed charges,80% of total billed charges,163.99,37.27,,131.19,percent of total billed charges,37.27% of total billed charges,163.99,37.27,,131.19,percent of total billed charges,37.27% of total billed charges,163.99,37.27,,131.19,percent of total billed charges,37.27% of total billed charges,164.29,100,,,fee schedule,100% of APC rate,164.29,100,,,fee schedule,100% of APC rate,164.29,100,,,fee schedule,100% of APC rate,25.91,145,,,fee schedule,145% of CMS fee schedule,164.29,100,,,fee schedule,100% of APC rate,164.29,100,,,fee schedule,100% of APC rate,164.29,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176,40,,140.8,percent of total billed charges,40% of total billed charges,25.91,352,
TUBE RECTAL 18FR,5645742,CDM,270,RC,,,Outpatient,,,31,24.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% 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,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,11.55,24.8,
RELEASE DRESSING 2X3,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
RELEASE DRESSING 3X4,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
TUBE SALEM SUMP,5645742,CDM,270,RC,,,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% 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,10,40,,8,percent of total billed charges,40% of total billed charges,9.32,20,
COUPLER SAMPLING SIT,5645742,CDM,270,RC,,,Outpatient,,,4,3.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
SCALPEL SZ 10-15,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
SALINE POUR 1000CC,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
TRACH NECKBAND,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
EPIDURAL SET W/CATH,5645742,CDM,270,RC,,,Outpatient,,,83,66.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% 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,33.2,40,,26.56,percent of total billed charges,40% of total billed charges,30.93,66.4,
EPIDURAL KIT W/MEDIC,5645742,CDM,270,RC,,,Outpatient,,,164,131.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,61.12,37.27,,48.9,percent of total billed charges,37.27% of total billed charges,61.12,37.27,,48.9,percent of total billed charges,37.27% of total billed charges,61.12,37.27,,48.9,percent of total billed charges,37.27% 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,65.6,40,,52.48,percent of total billed charges,40% of total billed charges,61.12,131.2,
SITZ BATH DISP,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
SKIN STAPLE REMOVER,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
SPONGE DRESSING,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
SPONGE GAUZE STERILE,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
EPISEAL STERI STRIP,5645742,CDM,270,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
STERI STRIP,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
STOCKING KNEE MED RG,5645742,CDM,270,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
STOCKING THIGH MED R,5645742,CDM,270,RC,,,Outpatient,,,31,24.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% 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,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,11.55,24.8,
STOP COCK 3 WAY,5645742,CDM,270,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
STYLET ADULT 6F SM-L,5645742,CDM,270,RC,,,Outpatient,,,26,20.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% 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,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,9.69,20.8,
CENTRAL LINE TRAY,5645742,CDM,270,RC,,,Outpatient,,,68,54.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% 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,27.2,40,,21.76,percent of total billed charges,40% of total billed charges,25.34,54.4,
CANNISTER SUCTION LG,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
CANNISTER SUCTION SM,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
TUBING SUCTION 1/4X1,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
DRESSING SURG 3X8,5801832,CDM,272,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
DRESSING SURG 4X6,5801832,CDM,272,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
DRESSING SURG 8X6,5801832,CDM,272,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
SURGIPAD 8X10,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
SUSPENSORY SM-LG,5645742,CDM,270,RC,,,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% 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,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,18.26,39.2,
SUTURE CG924,5801832,CDM,272,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
SUTURE SS684,5801832,CDM,272,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
SUTURE SS685,5801832,CDM,272,RC,,,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% 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,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,8.94,19.2,
TRAY THORA DISP 17X6,5645742,CDM,270,RC,,,Outpatient,,,204,163.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% 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,81.6,40,,65.28,percent of total billed charges,40% of total billed charges,76.03,163.2,
SUTURE CG983,5801832,CDM,272,RC,,,Outpatient,,,58,46.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% 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,23.2,40,,18.56,percent of total billed charges,40% of total billed charges,21.62,46.4,
SUTURE REMOVER,5801832,CDM,272,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
CATH SWANZ GANZ,5645742,CDM,270,RC,,,Outpatient,,,477,381.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,381.6,80,,305.28,percent of total billed charges,80% of total billed charges,177.78,37.27,,142.22,percent of total billed charges,37.27% of total billed charges,177.78,37.27,,142.22,percent of total billed charges,37.27% of total billed charges,177.78,37.27,,142.22,percent of total billed charges,37.27% 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,190.8,40,,152.64,percent of total billed charges,40% of total billed charges,177.78,381.6,
CENTRAL VENOUS PRESS,5645742,CDM,270,RC,,,Outpatient,,,37,29.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% 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,14.8,40,,11.84,percent of total billed charges,40% of total billed charges,13.79,29.6,
SYRINGE,5645742,CDM,270,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
SYRINGE 60CC,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
SYRINGE EAR BULB,5645742,CDM,270,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
TAPE MEDIRIP 4,5645742,CDM,270,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
TAPE UMBILICAL 1/4,5645742,CDM,270,RC,,,Outpatient,,,40,32.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% 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,16,40,,12.8,percent of total billed charges,40% of total billed charges,14.91,32,
THERMOMETER,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
THORA SEAL III CL CH,5645742,CDM,270,RC,,,Outpatient,,,125,100.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100,80,,80,percent of total billed charges,80% of total billed charges,46.59,37.27,,37.27,percent of total billed charges,37.27% of total billed charges,46.59,37.27,,37.27,percent of total billed charges,37.27% of total billed charges,46.59,37.27,,37.27,percent of total billed charges,37.27% 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,50,40,,40,percent of total billed charges,40% of total billed charges,46.59,100,
THORA SEAL III CHE D,5645742,CDM,270,RC,,,Outpatient,,,327,261.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,261.6,80,,209.28,percent of total billed charges,80% of total billed charges,121.87,37.27,,97.5,percent of total billed charges,37.27% of total billed charges,121.87,37.27,,97.5,percent of total billed charges,37.27% of total billed charges,121.87,37.27,,97.5,percent of total billed charges,37.27% 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,130.8,40,,104.64,percent of total billed charges,40% of total billed charges,121.87,261.6,
THORA SEAL CHEST DRG,5645742,CDM,270,RC,,,Outpatient,,,37,29.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% 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,14.8,40,,11.84,percent of total billed charges,40% of total billed charges,13.79,29.6,
CHEST TUBE INSERTION,5645742,CDM,270,RC,,,Outpatient,,,68,54.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% 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,27.2,40,,21.76,percent of total billed charges,40% of total billed charges,25.34,54.4,
TRACH CARE 14.0 FR,5645742,CDM,270,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
TUBE TRACH 4 CFN,5645742,CDM,270,RC,,,Outpatient,,,103,82.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% 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,41.2,40,,32.96,percent of total billed charges,40% of total billed charges,38.39,82.4,
TUBE TRACH DISP 4DCT,5645742,CDM,270,RC,,,Outpatient,,,152,121.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,56.65,37.27,,45.32,percent of total billed charges,37.27% of total billed charges,56.65,37.27,,45.32,percent of total billed charges,37.27% of total billed charges,56.65,37.27,,45.32,percent of total billed charges,37.27% 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,60.8,40,,48.64,percent of total billed charges,40% of total billed charges,56.65,121.6,
TUBE TRACH 8FEN 12X8,5645742,CDM,270,RC,,,Outpatient,,,237,189.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.6,80,,151.68,percent of total billed charges,80% of total billed charges,88.33,37.27,,70.66,percent of total billed charges,37.27% of total billed charges,88.33,37.27,,70.66,percent of total billed charges,37.27% of total billed charges,88.33,37.27,,70.66,percent of total billed charges,37.27% 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,94.8,40,,75.84,percent of total billed charges,40% of total billed charges,88.33,189.6,
TUBE TRACH DISP 8DCT,5645742,CDM,270,RC,,,Outpatient,,,152,121.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,56.65,37.27,,45.32,percent of total billed charges,37.27% of total billed charges,56.65,37.27,,45.32,percent of total billed charges,37.27% of total billed charges,56.65,37.27,,45.32,percent of total billed charges,37.27% 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,60.8,40,,48.64,percent of total billed charges,40% of total billed charges,56.65,121.6,
TUBE TRACH 8 LPC CUF,5645742,CDM,270,RC,,,Outpatient,,,233,186.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186.4,80,,149.12,percent of total billed charges,80% of total billed charges,86.84,37.27,,69.47,percent of total billed charges,37.27% of total billed charges,86.84,37.27,,69.47,percent of total billed charges,37.27% of total billed charges,86.84,37.27,,69.47,percent of total billed charges,37.27% 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,93.2,40,,74.56,percent of total billed charges,40% of total billed charges,86.84,186.4,
TRACHEOSTOMY CARE TR,5645742,CDM,270,RC,,,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
TRANSDUCER GOULD A-L,5645742,CDM,270,RC,,,Outpatient,,,90,72.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% 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,36,40,,28.8,percent of total billed charges,40% of total billed charges,33.54,72,
TUBE ENDO 1.0-5.5 UN,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
TUBING CONN PLAST 6I,5645742,CDM,270,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
TUBING CONN PLAST ST,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
UNDERPAD,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
SUTURE GL123,5801832,CDM,272,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
URINAL DISP,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
METER URNIE W/BAG,5645742,CDM,270,RC,,,Outpatient,,,42,33.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% 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,16.8,40,,13.44,percent of total billed charges,40% of total billed charges,15.65,33.6,
VASELINE GAUZE,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
WALKER EQUALIZER,5645742,CDM,270,RC,,,Outpatient,,,151,120.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% 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,60.4,40,,48.32,percent of total billed charges,40% of total billed charges,56.28,120.8,
IV CATH EXT SET,5645742,CDM,270,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
IV BURETROL SET,5645742,CDM,270,RC,,,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
IV CANNULA LEVER LOC,5645742,CDM,270,RC,,,Outpatient,,,2,1.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
IV CANNULA THREADED,5645742,CDM,270,RC,,,Outpatient,,,2,1.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
IV DIAL A FLO,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV EXT SET CATH NDLS,5645742,CDM,270,RC,,,Outpatient,,,52,41.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% 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,20.8,40,,16.64,percent of total billed charges,40% of total billed charges,19.38,41.6,
IV EXT SET WITH T,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV INJ CAP NEEDLELES,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
IV CATH JELCO 18G-24,5645742,CDM,270,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
IV CATH 18G JELCO,5645742,CDM,270,RC,,,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% 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,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,8.94,19.2,
IV START KIT,5645742,CDM,270,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
IV Y TYPE,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
IV Y TYPE BLOOD SOL,5645742,CDM,270,RC,,,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% 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,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,10.44,22.4,
IV MICRODRIP SET,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
IV MINICATH 23G,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
IV SECONDARY PIGGY B,5645742,CDM,270,RC,,,Outpatient,,,6.7,5.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.36,80,,4.29,percent of total billed charges,80% of total billed charges,2.5,37.27,,2,percent of total billed charges,37.27% of total billed charges,2.5,37.27,,2,percent of total billed charges,37.27% of total billed charges,2.5,37.27,,2,percent of total billed charges,37.27% 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,2.68,40,,2.14,percent of total billed charges,40% of total billed charges,2.5,5.36,
IV SOLUTION ADM SET,5645742,CDM,270,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
IV SOL SET VENTED IN,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
IV SOLUTION SET VENT,5645742,CDM,270,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
IV TWINSITE,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
IV TWINSITE EXT SET,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV VENO CONTINU FLO,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
MYELOGRAM LUMBAR-ADM,6000160,CDM,361,RC,62284,HCPCS,Outpatient,,,675,540.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540,80,,432,percent of total billed charges,80% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.42,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,270,40,,216,percent of total billed charges,40% of total billed charges,115.42,540,
SALPINGOGRAM TRAY,6000236,CDM,621,RC,,,Outpatient,,,185,148.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148,80,,118.4,percent of total billed charges,80% of total billed charges,68.95,37.27,,55.16,percent of total billed charges,37.27% of total billed charges,68.95,37.27,,55.16,percent of total billed charges,37.27% of total billed charges,68.95,37.27,,55.16,percent of total billed charges,37.27% 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,74,40,,59.2,percent of total billed charges,40% of total billed charges,68.95,148,
SUPER XL ENEMA BAG,6000236,CDM,621,RC,,,Outpatient,,,26,20.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% 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,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,9.69,20.8,
BARIUM ENEMA BAG,6000236,CDM,621,RC,,,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% 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,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,10.44,22.4,
CONDOM (VAG PROBE),5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
SM BOWEL SERIES-GAS,6000392,CDM,320,RC,74250,HCPCS,Outpatient,,,400,320.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,320,80,,256,percent of total billed charges,80% of total billed charges,149.08,37.27,,119.26,percent of total billed charges,37.27% of total billed charges,149.08,37.27,,119.26,percent of total billed charges,37.27% of total billed charges,149.08,37.27,,119.26,percent of total billed charges,37.27% of total billed charges,151.48,100,,,fee schedule,100% of APC rate,151.48,100,,,fee schedule,100% of APC rate,151.48,100,,,fee schedule,100% of APC rate,106.68,145,,,fee schedule,145% of CMS fee schedule,151.48,100,,,fee schedule,100% of APC rate,151.48,100,,,fee schedule,100% of APC rate,151.48,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160,40,,128,percent of total billed charges,40% of total billed charges,106.68,320,
X-RAY FILM DUP,5645742,CDM,270,RC,,,Outpatient,,,4,3.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
ABDOMEN 1 VW,6000392,CDM,320,RC,74018,HCPCS,Outpatient,,,210,168.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168,80,,134.4,percent of total billed charges,80% of total billed charges,78.27,37.27,,62.62,percent of total billed charges,37.27% of total billed charges,78.27,37.27,,62.62,percent of total billed charges,37.27% of total billed charges,78.27,37.27,,62.62,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,27.61,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,40,,67.2,percent of total billed charges,40% of total billed charges,27.61,168,
ABDOMEN 2 VW,6000392,CDM,320,RC,74019,HCPCS,Outpatient,,,263,210.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,33.1,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.2,40,,84.16,percent of total billed charges,40% of total billed charges,33.1,210.4,
ABDOMEN 3 VW,6000392,CDM,320,RC,74021,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,38.6,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,38.6,300,
US ABDOMEN COMPLETE,6000566,CDM,402,RC,76700,HCPCS,Outpatient,,,325,260.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260,80,,208,percent of total billed charges,80% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,100.04,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130,40,,104,percent of total billed charges,40% of total billed charges,90.64,260,
CERVICAL SP1 VW,6000392,CDM,320,RC,72020,HCPCS,Outpatient,,,300,240.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,21.26,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,21.26,240,
CHEST 1VIEW,6000392,CDM,320,RC,71045,HCPCS,Outpatient,,,250,200.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200,80,,160,percent of total billed charges,80% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,22.11,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100,40,,80,percent of total billed charges,40% of total billed charges,22.11,200,
CHEST PA & LAT,6000392,CDM,320,RC,71046,HCPCS,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,29.73,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110,40,,88,percent of total billed charges,40% of total billed charges,29.73,220,
RIBS BILAT 4+ VWS,6000392,CDM,320,RC,71110,HCPCS,Outpatient,,,368,294.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,38.6,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.2,40,,117.76,percent of total billed charges,40% of total billed charges,38.6,294.4,
STERNUM 2+VWS,6000392,CDM,320,RC,71120,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,30.99,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,30.99,264,
STERNO-CLAV JTS3+VWS,6000392,CDM,320,RC,71130,HCPCS,Outpatient,,,330,264.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,39.44,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,39.44,264,
CLAVICLE 2 VIEWS,6000392,CDM,320,RC,73000,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,31.41,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,31.41,264,
ELBOW 3+ VWS,6000392,CDM,320,RC,73080,HCPCS,Outpatient,,,315,252.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252,80,,201.6,percent of total billed charges,80% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,31.41,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126,40,,100.8,percent of total billed charges,40% of total billed charges,31.41,252,
FINGER 2+VWS,6000392,CDM,320,RC,73140,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,40.3,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,40.3,264,
FOREARM 2VS,6000392,CDM,320,RC,73090,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,27.61,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,27.61,264,
HAND 2 VW,6000392,CDM,320,RC,73120,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,30.15,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,30.15,264,
HUMERUS 2+VWS,6000392,CDM,320,RC,73060,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,30.99,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,30.99,264,
ISOVUE 200,6000905,CDM,255,RC,Q9966,HCPCS,Outpatient,,,219,175.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.2,80,,140.16,percent of total billed charges,80% of total billed charges,81.62,37.27,,65.3,percent of total billed charges,37.27% of total billed charges,81.62,37.27,,65.3,percent of total billed charges,37.27% of total billed charges,81.62,37.27,,65.3,percent of total billed charges,37.27% 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,87.6,40,,70.08,percent of total billed charges,40% of total billed charges,81.62,175.2,
SCAPULA 2 VW,6000392,CDM,320,RC,73010,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,19.58,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,19.58,264,
SHOULDER 2 VW,6000392,CDM,320,RC,73030,HCPCS,Outpatient,,,315,252.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252,80,,201.6,percent of total billed charges,80% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,33.1,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126,40,,100.8,percent of total billed charges,40% of total billed charges,33.1,252,
SHOULDER AP,6000392,CDM,320,RC,73020,HCPCS,Outpatient,,,263,210.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,18.3,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.2,40,,84.16,percent of total billed charges,40% of total billed charges,18.3,210.4,
WRIST 3+ VWS,6000392,CDM,320,RC,73110,HCPCS,Outpatient,,,315,252.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252,80,,201.6,percent of total billed charges,80% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,41.98,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126,40,,100.8,percent of total billed charges,40% of total billed charges,41.98,252,
ANKLE 3 VIEWS,6000392,CDM,320,RC,73610,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,36.06,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,36.06,264,
FEMUR 2 VW,6000392,CDM,320,RC,73552,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,34.37,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,34.37,264,
FOOT 2 VIEWS,6000392,CDM,320,RC,73620,HCPCS,Outpatient,,,263,210.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,27.19,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.2,40,,84.16,percent of total billed charges,40% of total billed charges,27.19,210.4,
HIP UNI W/PEL 2-3 VW,6000392,CDM,320,RC,73502,HCPCS,Outpatient,,,315,252.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252,80,,201.6,percent of total billed charges,80% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,47.05,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126,40,,100.8,percent of total billed charges,40% of total billed charges,47.05,252,
KNEE 3 VIEWS,6000392,CDM,320,RC,73562,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,40.72,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,40.72,264,
TIBIA/FIBULA 2 VW,6000392,CDM,320,RC,73590,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,30.57,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,30.57,264,
LONG BONES,6000392,CDM,320,RC,77073,HCPCS,Outpatient,,,184,147.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.2,80,,117.76,percent of total billed charges,80% of total billed charges,68.58,37.27,,54.86,percent of total billed charges,37.27% of total billed charges,68.58,37.27,,54.86,percent of total billed charges,37.27% of total billed charges,68.58,37.27,,54.86,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,41.14,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,40,,58.88,percent of total billed charges,40% of total billed charges,41.14,147.2,
TOES 2+VWS,6000392,CDM,320,RC,73660,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,29.29,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,29.29,264,
BONE AGE COMP,6000392,CDM,320,RC,77072,HCPCS,Outpatient,,,144,115.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,21.69,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,40,,46.08,percent of total billed charges,40% of total billed charges,21.69,115.2,
OS CALCANEUS 2+VWS,6000392,CDM,320,RC,73650,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,26.75,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,26.75,264,
CYSTOGRAM 3+ VWS,6000392,CDM,320,RC,74430,HCPCS,Outpatient,,,584,467.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,467.2,80,,373.76,percent of total billed charges,80% of total billed charges,217.66,37.27,,174.13,percent of total billed charges,37.27% of total billed charges,217.66,37.27,,174.13,percent of total billed charges,37.27% of total billed charges,217.66,37.27,,174.13,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,33.52,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,233.6,40,,186.88,percent of total billed charges,40% of total billed charges,33.52,467.2,
PYELOGRAM IV,6000392,CDM,320,RC,74400,HCPCS,Outpatient,,,709,567.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,567.2,80,,453.76,percent of total billed charges,80% of total billed charges,264.24,37.27,,211.39,percent of total billed charges,37.27% of total billed charges,264.24,37.27,,211.39,percent of total billed charges,37.27% of total billed charges,264.24,37.27,,211.39,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,142.32,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.6,40,,226.88,percent of total billed charges,40% of total billed charges,142.32,567.2,
FACIAL BONES 3+VWS,6000392,CDM,320,RC,70150,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,44.52,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,44.52,300,
MANDIBLE 4+ VWS,6000392,CDM,320,RC,70110,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,40.72,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,40.72,300,
FACIAL BONES <3V,6000392,CDM,320,RC,70140,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,28.87,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,28.87,264,
MASTOID 3+VWS,6000392,CDM,320,RC,70130,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,58.46,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,58.46,300,
NOSE 3+VWS,6000392,CDM,320,RC,70160,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,37.76,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,37.76,264,
SINUSES 3+ VWS,6000392,CDM,320,RC,70220,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,34.8,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,34.8,300,
SKULL 4+ VWS,6000392,CDM,320,RC,70260,HCPCS,Outpatient,,,365,292.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,292,80,,233.6,percent of total billed charges,80% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,39.86,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146,40,,116.8,percent of total billed charges,40% of total billed charges,39.86,292,
TMJ OPEN/CLOSED BILA,6000392,CDM,320,RC,70330,HCPCS,Outpatient,,,300,240.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,52.97,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,52.97,240,
C-SPINE 4 + VWS,6000392,CDM,320,RC,72050,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,52.13,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,52.13,300,
THORACIC SPINE 2VWS,6000392,CDM,320,RC,72070,HCPCS,Outpatient,,,263,210.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,29.73,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.2,40,,84.16,percent of total billed charges,40% of total billed charges,29.73,210.4,
LUMBAR SPINE 1 VW,6000392,CDM,320,RC,72020,HCPCS,Outpatient,,,300,240.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,21.26,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,21.26,240,
L-SPINE 2 OR 3 VWS,6000392,CDM,320,RC,72100,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,37.32,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,37.32,264,
LUMBAR W/OBL 4+ VWS,6000392,CDM,320,RC,72110,HCPCS,Outpatient,,,368,294.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,50.43,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.2,40,,117.76,percent of total billed charges,40% of total billed charges,50.43,294.4,
PELVIS 1-2 VWS,6000392,CDM,320,RC,72170,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,25.07,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,25.07,264,
SM BOWEL SERIES,6000392,CDM,320,RC,74250,HCPCS,Outpatient,,,400,320.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,320,80,,256,percent of total billed charges,80% of total billed charges,149.08,37.27,,119.26,percent of total billed charges,37.27% of total billed charges,149.08,37.27,,119.26,percent of total billed charges,37.27% of total billed charges,149.08,37.27,,119.26,percent of total billed charges,37.27% of total billed charges,151.48,100,,,fee schedule,100% of APC rate,151.48,100,,,fee schedule,100% of APC rate,151.48,100,,,fee schedule,100% of APC rate,106.68,145,,,fee schedule,145% of CMS fee schedule,151.48,100,,,fee schedule,100% of APC rate,151.48,100,,,fee schedule,100% of APC rate,151.48,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160,40,,128,percent of total billed charges,40% of total billed charges,106.68,320,
SI JOINTS 3+VWS,6000392,CDM,320,RC,72202,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,36.48,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,36.48,264,
SACRUM COCCYX MIN 2,6000392,CDM,320,RC,72220,HCPCS,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,30.99,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198,40,,158.4,percent of total billed charges,40% of total billed charges,30.99,396,
NM PARATHYROID SCAN,6001655,CDM,341,RC,78070,HCPCS,Outpatient,,,1121,896.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,896.8,80,,717.44,percent of total billed charges,80% of total billed charges,417.8,37.27,,334.24,percent of total billed charges,37.27% of total billed charges,417.8,37.27,,334.24,percent of total billed charges,37.27% of total billed charges,417.8,37.27,,334.24,percent of total billed charges,37.27% of total billed charges,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,295.35,145,,,fee schedule,145% of CMS fee schedule,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,448.4,40,,358.72,percent of total billed charges,40% of total billed charges,295.35,896.8,
FLUOROSC UP TO 1 HR,6000392,CDM,320,RC,76000,HCPCS,Outpatient,,,449,359.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,359.2,80,,287.36,percent of total billed charges,80% of total billed charges,167.34,37.27,,133.87,percent of total billed charges,37.27% of total billed charges,167.34,37.27,,133.87,percent of total billed charges,37.27% of total billed charges,167.34,37.27,,133.87,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,35.64,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.6,40,,143.68,percent of total billed charges,40% of total billed charges,35.64,359.2,
MYELOGRAM LUMBAR,6000392,CDM,320,RC,72265,HCPCS,Outpatient,,,2226,1780.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1780.8,80,,1424.64,percent of total billed charges,80% of total billed charges,829.63,37.27,,663.7,percent of total billed charges,37.27% of total billed charges,829.63,37.27,,663.7,percent of total billed charges,37.27% of total billed charges,829.63,37.27,,663.7,percent of total billed charges,37.27% of total billed charges,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,88.49,145,,,fee schedule,145% of CMS fee schedule,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,890.4,40,,712.32,percent of total billed charges,40% of total billed charges,88.49,1780.8,
ORBITS 4+VWS,6000392,CDM,320,RC,70200,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,44.09,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,44.09,264,
MOBILIZER USE,6000236,CDM,621,RC,,,Outpatient,,,41,32.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% 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,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,15.28,32.8,
ARTERIOGRAM SUPPLIES,5645742,CDM,270,RC,,,Outpatient,,,771,616.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,616.8,80,,493.44,percent of total billed charges,80% of total billed charges,287.35,37.27,,229.88,percent of total billed charges,37.27% of total billed charges,287.35,37.27,,229.88,percent of total billed charges,37.27% of total billed charges,287.35,37.27,,229.88,percent of total billed charges,37.27% 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,308.4,40,,246.72,percent of total billed charges,40% of total billed charges,287.35,616.8,
MYELOGRAM TRAY,6000236,CDM,621,RC,,,Outpatient,,,185,148.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148,80,,118.4,percent of total billed charges,80% of total billed charges,68.95,37.27,,55.16,percent of total billed charges,37.27% of total billed charges,68.95,37.27,,55.16,percent of total billed charges,37.27% of total billed charges,68.95,37.27,,55.16,percent of total billed charges,37.27% 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,74,40,,59.2,percent of total billed charges,40% of total billed charges,68.95,148,
ARTHOGRAM TRAY,6000236,CDM,621,RC,,,Outpatient,,,161,128.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% 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,64.4,40,,51.52,percent of total billed charges,40% of total billed charges,60,128.8,
SKULL < 4VWS,6000392,CDM,320,RC,70250,HCPCS,Outpatient,,,305,244.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244,80,,195.2,percent of total billed charges,80% of total billed charges,113.67,37.27,,90.94,percent of total billed charges,37.27% of total billed charges,113.67,37.27,,90.94,percent of total billed charges,37.27% of total billed charges,113.67,37.27,,90.94,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,34.8,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122,40,,97.6,percent of total billed charges,40% of total billed charges,34.8,244,
THORACIC SPINE 1 VW,6000392,CDM,320,RC,72020,HCPCS,Outpatient,,,300,240.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,21.26,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,21.26,240,
C-SPINE 2 OR 3 VWS,6000392,CDM,320,RC,72040,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,36.9,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,36.9,264,
BUTTERFLY,5645742,CDM,270,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
ENTERO VU 95,6000236,CDM,621,RC,,,Outpatient,,,104,83.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,38.76,37.27,,31.01,percent of total billed charges,37.27% of total billed charges,38.76,37.27,,31.01,percent of total billed charges,37.27% of total billed charges,38.76,37.27,,31.01,percent of total billed charges,37.27% 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,41.6,40,,33.28,percent of total billed charges,40% of total billed charges,38.76,83.2,
PELVIS-P,6000392,CDM,320,RC,72170,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,25.07,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,25.07,264,
ECG ELECTRODE PADS,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
MAMMALOC HOMER W/2.5,6000236,CDM,621,RC,,,Outpatient,,,211,168.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.8,80,,135.04,percent of total billed charges,80% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% 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,84.4,40,,67.52,percent of total billed charges,40% of total billed charges,78.64,168.8,
CT HEAD WO,6010003,CDM,351,RC,70450,HCPCS,Outpatient,,,1500,1200.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1200,80,,960,percent of total billed charges,80% of total billed charges,559.05,37.27,,447.24,percent of total billed charges,37.27% of total billed charges,559.05,37.27,,447.24,percent of total billed charges,37.27% of total billed charges,559.05,37.27,,447.24,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,87.65,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600,40,,480,percent of total billed charges,40% of total billed charges,87.65,1200,
CT HEAD (WO&W),6010003,CDM,351,RC,70470,HCPCS,Outpatient,,,2124,1699.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1699.2,80,,1359.36,percent of total billed charges,80% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,150.35,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,849.6,40,,679.68,percent of total billed charges,40% of total billed charges,150.35,1699.2,
SINUSES <3V,6000392,CDM,320,RC,70210,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,30.57,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,30.57,264,
CT NECK (W),6010052,CDM,350,RC,70491,HCPCS,Outpatient,,,2124,1699.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1699.2,80,,1359.36,percent of total billed charges,80% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,157.96,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,849.6,40,,679.68,percent of total billed charges,40% of total billed charges,151.49,1699.2,
CT THORAX (W),6010052,CDM,350,RC,71260,HCPCS,Outpatient,,,2124,1699.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1699.2,80,,1359.36,percent of total billed charges,80% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,148.23,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,849.6,40,,679.68,percent of total billed charges,40% of total billed charges,148.23,1699.2,
CT THORAX (WO&W),6010052,CDM,350,RC,71270,HCPCS,Outpatient,,,2399,1919.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1919.2,80,,1535.36,percent of total billed charges,80% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,181.64,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,959.6,40,,767.68,percent of total billed charges,40% of total billed charges,151.49,1919.2,
CT ABDOMEN WO,6010052,CDM,350,RC,74150,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,107.1,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,90.64,1316,
CT ABDOMEN W&WO CONT,6010052,CDM,350,RC,74170,HCPCS,Outpatient,,,2399,1919.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1919.2,80,,1535.36,percent of total billed charges,80% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,258.59,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,959.6,40,,767.68,percent of total billed charges,40% of total billed charges,151.49,1919.2,
CT PELVIS WO,6010052,CDM,350,RC,72192,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,108.36,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,90.64,1316,
CT PELVIS (WO&W),6010052,CDM,350,RC,72194,HCPCS,Outpatient,,,2399,1919.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1919.2,80,,1535.36,percent of total billed charges,80% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,257.33,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,959.6,40,,767.68,percent of total billed charges,40% of total billed charges,151.49,1919.2,
CT THORAX WO,6010052,CDM,350,RC,71250,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,108.79,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,90.64,1316,
CT ABDOMEN (W),6010052,CDM,350,RC,74160,HCPCS,Outpatient,,,2124,1699.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1699.2,80,,1359.36,percent of total billed charges,80% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,228.16,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,849.6,40,,679.68,percent of total billed charges,40% of total billed charges,151.49,1699.2,
CT PELVIS (W),6010052,CDM,350,RC,72193,HCPCS,Outpatient,,,2124,1699.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1699.2,80,,1359.36,percent of total billed charges,80% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,229.42,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,849.6,40,,679.68,percent of total billed charges,40% of total billed charges,151.49,1699.2,
CT SINUSES WO,6010052,CDM,350,RC,70486,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,115.97,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,90.64,1316,
CT GUIDED NEEDLE PLC,6010052,CDM,350,RC,77012,HCPCS,Outpatient,,,1596,1276.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1276.8,80,,1021.44,percent of total billed charges,80% of total billed charges,594.83,37.27,,475.86,percent of total billed charges,37.27% of total billed charges,594.83,37.27,,475.86,percent of total billed charges,37.27% of total billed charges,594.83,37.27,,475.86,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.76,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,638.4,40,,510.72,percent of total billed charges,40% of total billed charges,89.76,1276.8,
CT EXTREM UPPER WO,6010052,CDM,350,RC,73200,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,150.64,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,90.64,1316,
OXILAN 300,6000905,CDM,255,RC,,,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% 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,28,40,,22.4,percent of total billed charges,40% of total billed charges,26.09,56,
CT SELLA/IAC/ORB/WO,6010052,CDM,350,RC,70480,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,130.49,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,90.64,1316,
CATH HYSTEROSALPINGO,6000236,CDM,621,RC,,,Outpatient,,,136,108.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% 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,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,50.69,108.8,
US RENAL ARTERIES CO,6012447,CDM,921,RC,93975,HCPCS,Outpatient,,,787,629.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,629.6,80,,503.68,percent of total billed charges,80% of total billed charges,293.31,37.27,,234.65,percent of total billed charges,37.27% of total billed charges,293.31,37.27,,234.65,percent of total billed charges,37.27% of total billed charges,293.31,37.27,,234.65,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,267.31,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.8,40,,251.84,percent of total billed charges,40% of total billed charges,202.03,629.6,
US FETAL-LIMITED,6000566,CDM,402,RC,76815,HCPCS,Outpatient,,,720,576.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,64.39,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,40,,230.4,percent of total billed charges,40% of total billed charges,64.39,576,
CT BIOPSY TRAY,6000236,CDM,621,RC,,,Outpatient,,,225,180.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,80,,144,percent of total billed charges,80% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% 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,90,40,,72,percent of total billed charges,40% of total billed charges,83.86,180,
EZM CTH 13MM #ET-420,6000236,CDM,621,RC,,,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% 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,132,40,,105.6,percent of total billed charges,40% of total billed charges,122.99,264,
BETADINE,6000236,CDM,621,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
AMNIOCENTESIS TRAY,6000236,CDM,621,RC,,,Outpatient,,,185,148.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148,80,,118.4,percent of total billed charges,80% of total billed charges,68.95,37.27,,55.16,percent of total billed charges,37.27% of total billed charges,68.95,37.27,,55.16,percent of total billed charges,37.27% of total billed charges,68.95,37.27,,55.16,percent of total billed charges,37.27% 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,74,40,,59.2,percent of total billed charges,40% of total billed charges,68.95,148,
SINOGRAFIN,6000905,CDM,255,RC,,,Outpatient,,,114,91.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,42.49,37.27,,33.99,percent of total billed charges,37.27% of total billed charges,42.49,37.27,,33.99,percent of total billed charges,37.27% of total billed charges,42.49,37.27,,33.99,percent of total billed charges,37.27% 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,45.6,40,,36.48,percent of total billed charges,40% of total billed charges,42.49,91.2,
CIVCO BIOPSY SETUP,6000236,CDM,621,RC,,,Outpatient,,,239,191.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% 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,95.6,40,,76.48,percent of total billed charges,40% of total billed charges,89.08,191.2,
EXTENSION SET 30,6000236,CDM,621,RC,,,Outpatient,,,26,20.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% 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,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,9.69,20.8,
NM MAG 3 RENAL SCAN,6001655,CDM,341,RC,78707,HCPCS,Outpatient,,,936,748.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,748.8,80,,599.04,percent of total billed charges,80% of total billed charges,348.85,37.27,,279.08,percent of total billed charges,37.27% of total billed charges,348.85,37.27,,279.08,percent of total billed charges,37.27% of total billed charges,348.85,37.27,,279.08,percent of total billed charges,37.27% of total billed charges,445.65,100,,,fee schedule,100% of APC rate,445.65,100,,,fee schedule,100% of APC rate,445.65,100,,,fee schedule,100% of APC rate,218.27,145,,,fee schedule,145% of CMS fee schedule,445.65,100,,,fee schedule,100% of APC rate,445.65,100,,,fee schedule,100% of APC rate,445.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,374.4,40,,299.52,percent of total billed charges,40% of total billed charges,218.27,748.8,
US PROBE COVER,5645742,CDM,270,RC,,,Outpatient,,,32,25.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% 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,12.8,40,,10.24,percent of total billed charges,40% of total billed charges,11.93,25.6,
FACE MASK,6000236,CDM,621,RC,,,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% 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,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,8.94,19.2,
ENEMA TIPS,6000236,CDM,621,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
US VEN UPPER EXT BIL,6012447,CDM,921,RC,93970,HCPCS,Outpatient,,,1000,800.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,800,80,,640,percent of total billed charges,80% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,196.56,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,400,40,,320,percent of total billed charges,40% of total billed charges,196.56,800,
US VEN UPPER EXT UNI,6012447,CDM,921,RC,93971,HCPCS,Outpatient,,,686,548.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,548.8,80,,439.04,percent of total billed charges,80% of total billed charges,255.67,37.27,,204.54,percent of total billed charges,37.27% of total billed charges,255.67,37.27,,204.54,percent of total billed charges,37.27% of total billed charges,255.67,37.27,,204.54,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,124.98,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,274.4,40,,219.52,percent of total billed charges,40% of total billed charges,90.64,548.8,
US ART UPPER EXT UNI,6012447,CDM,921,RC,93931,HCPCS,Outpatient,,,686,548.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,548.8,80,,439.04,percent of total billed charges,80% of total billed charges,255.67,37.27,,204.54,percent of total billed charges,37.27% of total billed charges,255.67,37.27,,204.54,percent of total billed charges,37.27% of total billed charges,255.67,37.27,,204.54,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,127.95,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,274.4,40,,219.52,percent of total billed charges,40% of total billed charges,90.64,548.8,
US ART UPPER EXT BIL,6012447,CDM,921,RC,93930,HCPCS,Outpatient,,,1000,800.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,800,80,,640,percent of total billed charges,80% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,204.17,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,400,40,,320,percent of total billed charges,40% of total billed charges,202.03,800,
US CAROTID BI,6012447,CDM,921,RC,93880,HCPCS,Outpatient,,,1714,1371.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1371.2,80,,1096.96,percent of total billed charges,80% of total billed charges,638.81,37.27,,511.05,percent of total billed charges,37.27% of total billed charges,638.81,37.27,,511.05,percent of total billed charges,37.27% of total billed charges,638.81,37.27,,511.05,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,194.02,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,685.6,40,,548.48,percent of total billed charges,40% of total billed charges,194.02,1371.2,
US CAROTID UNI,6012447,CDM,921,RC,93882,HCPCS,Outpatient,,,857,685.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,685.6,80,,548.48,percent of total billed charges,80% of total billed charges,319.4,37.27,,255.52,percent of total billed charges,37.27% of total billed charges,319.4,37.27,,255.52,percent of total billed charges,37.27% of total billed charges,319.4,37.27,,255.52,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,128.79,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,342.8,40,,274.24,percent of total billed charges,40% of total billed charges,90.64,685.6,
US ART LOWER EXT BIL,6012447,CDM,921,RC,93925,HCPCS,Outpatient,,,1000,800.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,800,80,,640,percent of total billed charges,80% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,258.43,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,400,40,,320,percent of total billed charges,40% of total billed charges,202.03,800,
US ART LOWER EXT UNI,6012447,CDM,921,RC,93926,HCPCS,Outpatient,,,686,548.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,548.8,80,,439.04,percent of total billed charges,80% of total billed charges,255.67,37.27,,204.54,percent of total billed charges,37.27% of total billed charges,255.67,37.27,,204.54,percent of total billed charges,37.27% of total billed charges,255.67,37.27,,204.54,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,154.28,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,274.4,40,,219.52,percent of total billed charges,40% of total billed charges,90.64,548.8,
US VEN LOWER EXT BIL,6012447,CDM,921,RC,93970,HCPCS,Outpatient,,,1000,800.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,800,80,,640,percent of total billed charges,80% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,196.56,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,400,40,,320,percent of total billed charges,40% of total billed charges,196.56,800,
US VEN LOWER EXT UNI,6012447,CDM,921,RC,93971,HCPCS,Outpatient,,,686,548.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,548.8,80,,439.04,percent of total billed charges,80% of total billed charges,255.67,37.27,,204.54,percent of total billed charges,37.27% of total billed charges,255.67,37.27,,204.54,percent of total billed charges,37.27% of total billed charges,255.67,37.27,,204.54,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,124.98,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,274.4,40,,219.52,percent of total billed charges,40% of total billed charges,90.64,548.8,
NM 3 PHASE BONE SCAN,6001655,CDM,341,RC,78315,HCPCS,Outpatient,,,936,748.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,748.8,80,,599.04,percent of total billed charges,80% of total billed charges,348.85,37.27,,279.08,percent of total billed charges,37.27% of total billed charges,348.85,37.27,,279.08,percent of total billed charges,37.27% of total billed charges,348.85,37.27,,279.08,percent of total billed charges,37.27% of total billed charges,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,342.82,145,,,fee schedule,145% of CMS fee schedule,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,374.4,40,,299.52,percent of total billed charges,40% of total billed charges,340.06,748.8,
KINE-VAC 4MG,6065130,CDM,636,RC,J2805,HCPCS,Outpatient,,,179,143.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% 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,71.6,40,,57.28,percent of total billed charges,40% of total billed charges,66.71,143.2,
DOBUTAMINE 6 MG,6000905,CDM,255,RC,,,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% 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,132,40,,105.6,percent of total billed charges,40% of total billed charges,122.99,264,
ADENOSINE 6 MG,6065130,CDM,636,RC,J0153,HCPCS,Outpatient,,,900,720.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,720,80,,576,percent of total billed charges,80% of total billed charges,335.43,37.27,,268.34,percent of total billed charges,37.27% of total billed charges,335.43,37.27,,268.34,percent of total billed charges,37.27% of total billed charges,335.43,37.27,,268.34,percent of total billed charges,37.27% 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,360,40,,288,percent of total billed charges,40% of total billed charges,335.43,720,
NM TC04,6071625,CDM,343,RC,A9512,HCPCS,Outpatient,,,124,99.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,46.21,37.27,,36.97,percent of total billed charges,37.27% of total billed charges,46.21,37.27,,36.97,percent of total billed charges,37.27% of total billed charges,46.21,37.27,,36.97,percent of total billed charges,37.27% 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,49.6,40,,39.68,percent of total billed charges,40% of total billed charges,46.21,99.2,
CT EXTREM UPPER (W),6010052,CDM,350,RC,73201,HCPCS,Outpatient,,,2124,1699.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1699.2,80,,1359.36,percent of total billed charges,80% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,192.63,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,849.6,40,,679.68,percent of total billed charges,40% of total billed charges,192.63,1699.2,
CT EXTREM LOWER WO,6010052,CDM,350,RC,73700,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,109.21,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,90.64,1316,
US ABDOMEN LIMITED,6000566,CDM,402,RC,76705,HCPCS,Outpatient,,,575,460.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460,80,,368,percent of total billed charges,80% of total billed charges,214.3,37.27,,171.44,percent of total billed charges,37.27% of total billed charges,214.3,37.27,,171.44,percent of total billed charges,37.27% of total billed charges,214.3,37.27,,171.44,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,75.81,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230,40,,184,percent of total billed charges,40% of total billed charges,75.81,460,
US ABD ASCITES,6000566,CDM,402,RC,76700,HCPCS,Outpatient,,,325,260.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260,80,,208,percent of total billed charges,80% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,100.04,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130,40,,104,percent of total billed charges,40% of total billed charges,90.64,260,
US RETROPERIT LTD,6000566,CDM,402,RC,76775,HCPCS,Outpatient,,,575,460.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460,80,,368,percent of total billed charges,80% of total billed charges,214.3,37.27,,171.44,percent of total billed charges,37.27% of total billed charges,214.3,37.27,,171.44,percent of total billed charges,37.27% of total billed charges,214.3,37.27,,171.44,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,41.56,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230,40,,184,percent of total billed charges,40% of total billed charges,41.56,460,
US MALE PELVIS NONSC,6000566,CDM,402,RC,76856,HCPCS,Outpatient,,,720,576.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,93.15,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,40,,230.4,percent of total billed charges,40% of total billed charges,90.64,576,
US RETROPERIT COMP,6000566,CDM,402,RC,76770,HCPCS,Outpatient,,,325,260.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260,80,,208,percent of total billed charges,80% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,93.57,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130,40,,104,percent of total billed charges,40% of total billed charges,90.64,260,
US SOFT TISSUE HD/NK,6000566,CDM,402,RC,76536,HCPCS,Outpatient,,,428,342.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,342.4,80,,273.92,percent of total billed charges,80% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,106.68,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.2,40,,136.96,percent of total billed charges,40% of total billed charges,90.64,342.4,
US PREG TRANSAB >/=1,6000566,CDM,402,RC,76805,HCPCS,Outpatient,,,720,576.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,113.14,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,40,,230.4,percent of total billed charges,40% of total billed charges,90.64,576,
US PELVIC NON-OB COM,6000566,CDM,402,RC,76856,HCPCS,Outpatient,,,720,576.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,93.15,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,40,,230.4,percent of total billed charges,40% of total billed charges,90.64,576,
US SCROTUM,6000566,CDM,402,RC,76870,HCPCS,Outpatient,,,720,576.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,89.33,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,40,,230.4,percent of total billed charges,40% of total billed charges,89.33,576,
US VAG PROBE NON OB,6000566,CDM,402,RC,76830,HCPCS,Outpatient,,,720,576.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,110.61,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,40,,230.4,percent of total billed charges,40% of total billed charges,90.64,576,
NM TC RBC ULTRATAG,6071625,CDM,343,RC,A9560,HCPCS,Outpatient,,,297,237.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,110.69,37.27,,88.55,percent of total billed charges,37.27% of total billed charges,110.69,37.27,,88.55,percent of total billed charges,37.27% of total billed charges,110.69,37.27,,88.55,percent of total billed charges,37.27% 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,118.8,40,,95.04,percent of total billed charges,40% of total billed charges,110.69,237.6,
LIDOCAINE 50ML,6000905,CDM,255,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
SODIUM CHL INJ 10CC,6000905,CDM,255,RC,A4216,HCPCS,Outpatient,,,22,17.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.61,100,,,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,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,0.61,17.6,
GASTROGRAFIN,6000905,CDM,255,RC,,,Outpatient,,,45,36.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% 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,18,40,,14.4,percent of total billed charges,40% of total billed charges,16.77,36,
CYSTOGRAFIN,6000905,CDM,255,RC,,,Outpatient,,,135,108.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108,80,,86.4,percent of total billed charges,80% of total billed charges,50.31,37.27,,40.25,percent of total billed charges,37.27% of total billed charges,50.31,37.27,,40.25,percent of total billed charges,37.27% of total billed charges,50.31,37.27,,40.25,percent of total billed charges,37.27% 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,54,40,,43.2,percent of total billed charges,40% of total billed charges,50.31,108,
CT LUMB SPINE WO,6010052,CDM,350,RC,72131,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,108.79,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,90.64,1316,
CHOLOGRAFIN,6000905,CDM,255,RC,,,Outpatient,,,151,120.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.8,80,,96.64,percent of total billed charges,80% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% of total billed charges,56.28,37.27,,45.02,percent of total billed charges,37.27% 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,60.4,40,,48.32,percent of total billed charges,40% of total billed charges,56.28,120.8,
PROHANCE,6000905,CDM,255,RC,A9579,HCPCS,Outpatient,,,199,159.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% 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,79.6,40,,63.68,percent of total billed charges,40% of total billed charges,74.17,159.2,
CT CERV SPINE WO,6010052,CDM,350,RC,72125,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,110.06,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,90.64,1316,
NM BONE SCAN BODY,6001655,CDM,341,RC,78306,HCPCS,Outpatient,,,1414,1131.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1131.2,80,,904.96,percent of total billed charges,80% of total billed charges,527,37.27,,421.6,percent of total billed charges,37.27% of total billed charges,527,37.27,,421.6,percent of total billed charges,37.27% of total billed charges,527,37.27,,421.6,percent of total billed charges,37.27% of total billed charges,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,292.25,145,,,fee schedule,145% of CMS fee schedule,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,565.6,40,,452.48,percent of total billed charges,40% of total billed charges,292.25,1131.2,
NM BONE SCAN PARTIAL,6001655,CDM,341,RC,78300,HCPCS,Outpatient,,,785,628.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,628,80,,502.4,percent of total billed charges,80% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,226.17,145,,,fee schedule,145% of CMS fee schedule,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314,40,,251.2,percent of total billed charges,40% of total billed charges,226.17,628,
NM MUGA SCAN,6001655,CDM,341,RC,78472,HCPCS,Outpatient,,,1562,1249.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1249.6,80,,999.68,percent of total billed charges,80% of total billed charges,582.16,37.27,,465.73,percent of total billed charges,37.27% of total billed charges,582.16,37.27,,465.73,percent of total billed charges,37.27% of total billed charges,582.16,37.27,,465.73,percent of total billed charges,37.27% of total billed charges,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,210.22,145,,,fee schedule,145% of CMS fee schedule,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,624.8,40,,499.84,percent of total billed charges,40% of total billed charges,210.22,1249.6,
NM LIVER & SPLEEN SC,6001655,CDM,341,RC,78215,HCPCS,Outpatient,,,785,628.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,628,80,,502.4,percent of total billed charges,80% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,203.04,145,,,fee schedule,145% of CMS fee schedule,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314,40,,251.2,percent of total billed charges,40% of total billed charges,203.04,628,
NM LUNG PERF ONLY,6001655,CDM,341,RC,78580,HCPCS,Outpatient,,,833,666.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,666.4,80,,533.12,percent of total billed charges,80% of total billed charges,310.46,37.27,,248.37,percent of total billed charges,37.27% of total billed charges,310.46,37.27,,248.37,percent of total billed charges,37.27% of total billed charges,310.46,37.27,,248.37,percent of total billed charges,37.27% of total billed charges,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,232.22,145,,,fee schedule,145% of CMS fee schedule,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,333.2,40,,266.56,percent of total billed charges,40% of total billed charges,232.22,666.4,
NM THYROID SCAN,6001655,CDM,341,RC,78014,HCPCS,Outpatient,,,378,302.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,302.4,80,,241.92,percent of total billed charges,80% of total billed charges,140.88,37.27,,112.7,percent of total billed charges,37.27% of total billed charges,140.88,37.27,,112.7,percent of total billed charges,37.27% of total billed charges,140.88,37.27,,112.7,percent of total billed charges,37.27% of total billed charges,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,247.86,145,,,fee schedule,145% of CMS fee schedule,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.2,40,,120.96,percent of total billed charges,40% of total billed charges,140.88,340.06,
NM GASTRIC EMPTYING,6001655,CDM,341,RC,78264,HCPCS,Outpatient,,,936,748.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,748.8,80,,599.04,percent of total billed charges,80% of total billed charges,348.85,37.27,,279.08,percent of total billed charges,37.27% of total billed charges,348.85,37.27,,279.08,percent of total billed charges,37.27% of total billed charges,348.85,37.27,,279.08,percent of total billed charges,37.27% of total billed charges,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,337.75,145,,,fee schedule,145% of CMS fee schedule,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,374.4,40,,299.52,percent of total billed charges,40% of total billed charges,337.75,748.8,
NM ABD SCAN MICKELS,6001655,CDM,341,RC,78290,HCPCS,Outpatient,,,785,628.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,628,80,,502.4,percent of total billed charges,80% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,342.4,145,,,fee schedule,145% of CMS fee schedule,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314,40,,251.2,percent of total billed charges,40% of total billed charges,292.57,628,
NM TAGGED RED BLOOD,6001655,CDM,341,RC,78278,HCPCS,Outpatient,,,936,748.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,748.8,80,,599.04,percent of total billed charges,80% of total billed charges,348.85,37.27,,279.08,percent of total billed charges,37.27% of total billed charges,348.85,37.27,,279.08,percent of total billed charges,37.27% of total billed charges,348.85,37.27,,279.08,percent of total billed charges,37.27% of total billed charges,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,347.06,145,,,fee schedule,145% of CMS fee schedule,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,374.4,40,,299.52,percent of total billed charges,40% of total billed charges,340.06,748.8,
NM TC 99M SESTAMIBI,6071625,CDM,343,RC,A9500,HCPCS,Outpatient,,,474,379.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,379.2,80,,303.36,percent of total billed charges,80% of total billed charges,176.66,37.27,,141.33,percent of total billed charges,37.27% of total billed charges,176.66,37.27,,141.33,percent of total billed charges,37.27% of total billed charges,176.66,37.27,,141.33,percent of total billed charges,37.27% 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,189.6,40,,151.68,percent of total billed charges,40% of total billed charges,176.66,379.2,
CYSTOGRAM-VOIDING,6000392,CDM,320,RC,74455,HCPCS,Outpatient,,,584,467.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,467.2,80,,373.76,percent of total billed charges,80% of total billed charges,217.66,37.27,,174.13,percent of total billed charges,37.27% of total billed charges,217.66,37.27,,174.13,percent of total billed charges,37.27% of total billed charges,217.66,37.27,,174.13,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,112.59,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,233.6,40,,186.88,percent of total billed charges,40% of total billed charges,112.59,467.2,
CHOLETEC,6071625,CDM,343,RC,A9537,HCPCS,Outpatient,,,127,101.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% 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,50.8,40,,40.64,percent of total billed charges,40% of total billed charges,47.33,101.6,
MAA,6071625,CDM,343,RC,A9540,HCPCS,Outpatient,,,161,128.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% 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,64.4,40,,51.52,percent of total billed charges,40% of total billed charges,60,128.8,
MAG-3,6071625,CDM,343,RC,A9562,HCPCS,Outpatient,,,515,412.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412,80,,329.6,percent of total billed charges,80% of total billed charges,191.94,37.27,,153.55,percent of total billed charges,37.27% of total billed charges,191.94,37.27,,153.55,percent of total billed charges,37.27% of total billed charges,191.94,37.27,,153.55,percent of total billed charges,37.27% 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,206,40,,164.8,percent of total billed charges,40% of total billed charges,191.94,412,
SULFUR COLLOID-VIAL,6071625,CDM,343,RC,A9541,HCPCS,Outpatient,,,127,101.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% 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,50.8,40,,40.64,percent of total billed charges,40% of total billed charges,47.33,101.6,
MDP,6071625,CDM,343,RC,A9503,HCPCS,Outpatient,,,127,101.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% 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,50.8,40,,40.64,percent of total billed charges,40% of total billed charges,47.33,101.6,
INDIUM-III 3 MC,6071625,CDM,343,RC,A4641,HCPCS,Outpatient,,,2475,1980.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1980,80,,1584,percent of total billed charges,80% of total billed charges,922.43,37.27,,737.94,percent of total billed charges,37.27% of total billed charges,922.43,37.27,,737.94,percent of total billed charges,37.27% of total billed charges,922.43,37.27,,737.94,percent of total billed charges,37.27% 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,990,40,,792,percent of total billed charges,40% of total billed charges,922.43,1980,
XENON GAS,6071625,CDM,343,RC,A9558,HCPCS,Outpatient,,,145,116.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116,80,,92.8,percent of total billed charges,80% of total billed charges,54.04,37.27,,43.23,percent of total billed charges,37.27% of total billed charges,54.04,37.27,,43.23,percent of total billed charges,37.27% of total billed charges,54.04,37.27,,43.23,percent of total billed charges,37.27% 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,58,40,,46.4,percent of total billed charges,40% of total billed charges,54.04,116,
MRI SHOULDER WO CONT,6212047,CDM,610,RC,73221,HCPCS,Outpatient,,,3016,2412.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,184.18,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,184.18,2412.8,
MRI ABDOMEN WO CONT,6212047,CDM,610,RC,74181,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,168.95,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,168.95,2412.8,
MRI KNEE W&WO CONT,6212047,CDM,610,RC,73723,HCPCS,Outpatient,,,3564,2851.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,375.84,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,317.08,2851.2,
MRI ABDOMEN W/WO,6212047,CDM,610,RC,74183,HCPCS,Outpatient,,,3564,2851.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,311.16,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,311.16,2851.2,
MRA LOWER EXT W CONT,,,616,RC,73725,HCPCS,Outpatient,,,3016,2412.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332.01,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,332.01,2412.8,
MRA NECK W&WO CONT,6230478,CDM,615,RC,70549,HCPCS,Outpatient,,,3564,2851.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,344.68,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,317.08,2851.2,
MRI HIP WO CONT,6212047,CDM,610,RC,73721,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,183.76,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,183.76,2412.8,
PENTOTHAL NA 2.5% 25,6400014,CDM,250,RC,,,Outpatient,,,51.3,41.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.04,80,,32.83,percent of total billed charges,80% of total billed charges,19.12,37.27,,15.3,percent of total billed charges,37.27% of total billed charges,19.12,37.27,,15.3,percent of total billed charges,37.27% of total billed charges,19.12,37.27,,15.3,percent of total billed charges,37.27% 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,20.52,40,,16.42,percent of total billed charges,40% of total billed charges,19.12,41.04,
QUELICIN 20MG,6065130,CDM,636,RC,J0330,HCPCS,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
GLYCOPYROLATE 0.2MG/,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
PROCHLORPERAZINE SUP,6400014,CDM,250,RC,,,Outpatient,,,42.9,34.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.32,80,,27.46,percent of total billed charges,80% of total billed charges,15.99,37.27,,12.79,percent of total billed charges,37.27% of total billed charges,15.99,37.27,,12.79,percent of total billed charges,37.27% of total billed charges,15.99,37.27,,12.79,percent of total billed charges,37.27% 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,17.16,40,,13.73,percent of total billed charges,40% of total billed charges,15.99,34.32,
PROSTIGMIN (NEOSTIGM,6065130,CDM,636,RC,J2710,HCPCS,Outpatient,,,11.4,9.12,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
EPHEDRINE 50MG/ML AM,5880901,CDM,637,RC,,,Outpatient,,,193.5,154.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.8,80,,123.84,percent of total billed charges,80% of total billed charges,72.12,37.27,,57.7,percent of total billed charges,37.27% of total billed charges,72.12,37.27,,57.7,percent of total billed charges,37.27% of total billed charges,72.12,37.27,,57.7,percent of total billed charges,37.27% 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,77.4,40,,61.92,percent of total billed charges,40% of total billed charges,72.12,154.8,
EPINEPHRINE 1MG/ML A,6065130,CDM,636,RC,J0171,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
INDERAL 1MG/ML AMP,6065130,CDM,636,RC,J1800,HCPCS,Outpatient,,,61.25,49.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49,80,,39.2,percent of total billed charges,80% of total billed charges,22.83,37.27,,18.26,percent of total billed charges,37.27% of total billed charges,22.83,37.27,,18.26,percent of total billed charges,37.27% of total billed charges,22.83,37.27,,18.26,percent of total billed charges,37.27% 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,24.5,40,,19.6,percent of total billed charges,40% of total billed charges,22.83,49,
SEREVENT 21MCG INHAL,6400014,CDM,250,RC,,,Outpatient,,,150.35,120.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.28,80,,96.22,percent of total billed charges,80% of total billed charges,56.04,37.27,,44.83,percent of total billed charges,37.27% of total billed charges,56.04,37.27,,44.83,percent of total billed charges,37.27% of total billed charges,56.04,37.27,,44.83,percent of total billed charges,37.27% 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,60.14,40,,48.11,percent of total billed charges,40% of total billed charges,56.04,120.28,
XYLOCAINE 2%,6400014,CDM,250,RC,,,Outpatient,,,16.75,13.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.4,80,,10.72,percent of total billed charges,80% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% 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,6.7,40,,5.36,percent of total billed charges,40% of total billed charges,6.24,13.4,
FUROSEMIDE 20MG/2ML,6065130,CDM,636,RC,J1940,HCPCS,Outpatient,,,17.1,13.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.68,80,,10.94,percent of total billed charges,80% of total billed charges,6.37,37.27,,5.1,percent of total billed charges,37.27% of total billed charges,6.37,37.27,,5.1,percent of total billed charges,37.27% of total billed charges,6.37,37.27,,5.1,percent of total billed charges,37.27% 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,6.84,40,,5.47,percent of total billed charges,40% of total billed charges,6.37,13.68,
XYLOCAINE 100MG/5CC,6400014,CDM,250,RC,,,Outpatient,,,17.8,14.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.24,80,,11.39,percent of total billed charges,80% of total billed charges,6.63,37.27,,5.3,percent of total billed charges,37.27% of total billed charges,6.63,37.27,,5.3,percent of total billed charges,37.27% of total billed charges,6.63,37.27,,5.3,percent of total billed charges,37.27% 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,7.12,40,,5.7,percent of total billed charges,40% of total billed charges,6.63,14.24,
PREMARIN 0.9MG,6400014,CDM,250,RC,,,Outpatient,,,28.25,22.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.6,80,,18.08,percent of total billed charges,80% of total billed charges,10.53,37.27,,8.42,percent of total billed charges,37.27% of total billed charges,10.53,37.27,,8.42,percent of total billed charges,37.27% of total billed charges,10.53,37.27,,8.42,percent of total billed charges,37.27% 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,11.3,40,,9.04,percent of total billed charges,40% of total billed charges,10.53,22.6,
AMBIEN 5MG UD,6400014,CDM,250,RC,,,Outpatient,,,17.8,14.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.24,80,,11.39,percent of total billed charges,80% of total billed charges,6.63,37.27,,5.3,percent of total billed charges,37.27% of total billed charges,6.63,37.27,,5.3,percent of total billed charges,37.27% of total billed charges,6.63,37.27,,5.3,percent of total billed charges,37.27% 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,7.12,40,,5.7,percent of total billed charges,40% of total billed charges,6.63,14.24,
NEOSYNEPHRINE AMP,6400014,CDM,250,RC,,,Outpatient,,,20.15,16.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.12,80,,12.9,percent of total billed charges,80% of total billed charges,7.51,37.27,,6.01,percent of total billed charges,37.27% of total billed charges,7.51,37.27,,6.01,percent of total billed charges,37.27% of total billed charges,7.51,37.27,,6.01,percent of total billed charges,37.27% 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,8.06,40,,6.45,percent of total billed charges,40% of total billed charges,7.51,16.12,
KETAMINE 50MG/ML,6400014,CDM,250,RC,,,Outpatient,,,13.1,10.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.48,80,,8.38,percent of total billed charges,80% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% 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,5.24,40,,4.19,percent of total billed charges,40% of total billed charges,4.88,10.48,
NORCURON IV 10MG,6400014,CDM,250,RC,,,Outpatient,,,36.9,29.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.52,80,,23.62,percent of total billed charges,80% of total billed charges,13.75,37.27,,11,percent of total billed charges,37.27% of total billed charges,13.75,37.27,,11,percent of total billed charges,37.27% of total billed charges,13.75,37.27,,11,percent of total billed charges,37.27% 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,14.76,40,,11.81,percent of total billed charges,40% of total billed charges,13.75,29.52,
SILVER NITRATE APPLI,6400014,CDM,250,RC,,,Outpatient,,,8.18,6.54,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.54,80,,5.23,percent of total billed charges,80% of total billed charges,3.05,37.27,,2.44,percent of total billed charges,37.27% of total billed charges,3.05,37.27,,2.44,percent of total billed charges,37.27% of total billed charges,3.05,37.27,,2.44,percent of total billed charges,37.27% 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,3.27,40,,2.62,percent of total billed charges,40% of total billed charges,3.05,6.54,
CEFTIN 250MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,10.6,8.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.48,80,,6.78,percent of total billed charges,80% of total billed charges,3.95,37.27,,3.16,percent of total billed charges,37.27% of total billed charges,3.95,37.27,,3.16,percent of total billed charges,37.27% of total billed charges,3.95,37.27,,3.16,percent of total billed charges,37.27% 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,4.24,40,,3.39,percent of total billed charges,40% of total billed charges,3.95,8.48,
ACETYLCYSTEINE 10% 1,6400014,CDM,250,RC,A9270,HCPCS,Outpatient,,,84.9,67.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.92,80,,54.34,percent of total billed charges,80% of total billed charges,31.64,37.27,,25.31,percent of total billed charges,37.27% of total billed charges,31.64,37.27,,25.31,percent of total billed charges,37.27% of total billed charges,31.64,37.27,,25.31,percent of total billed charges,37.27% 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,33.96,40,,27.17,percent of total billed charges,40% of total billed charges,31.64,67.92,
ZANTAC 50MG/0.45NS 5,6065130,CDM,636,RC,J2780,HCPCS,Outpatient,,,58.2,46.56,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.56,80,,37.25,percent of total billed charges,80% of total billed charges,21.69,37.27,,17.35,percent of total billed charges,37.27% of total billed charges,21.69,37.27,,17.35,percent of total billed charges,37.27% of total billed charges,21.69,37.27,,17.35,percent of total billed charges,37.27% 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,23.28,40,,18.62,percent of total billed charges,40% of total billed charges,21.69,46.56,
HYTRIN 5 MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
NIZORAL SHAMPOO 4OZ,6400014,CDM,250,RC,,,Outpatient,,,54.56,43.65,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.65,80,,34.92,percent of total billed charges,80% of total billed charges,20.33,37.27,,16.26,percent of total billed charges,37.27% of total billed charges,20.33,37.27,,16.26,percent of total billed charges,37.27% of total billed charges,20.33,37.27,,16.26,percent of total billed charges,37.27% 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,21.82,40,,17.46,percent of total billed charges,40% of total billed charges,20.33,43.65,
ACETYLCYSTEINE 10% 3,6400014,CDM,250,RC,,,Outpatient,,,57.72,46.18,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.18,80,,36.94,percent of total billed charges,80% of total billed charges,21.51,37.27,,17.21,percent of total billed charges,37.27% of total billed charges,21.51,37.27,,17.21,percent of total billed charges,37.27% of total billed charges,21.51,37.27,,17.21,percent of total billed charges,37.27% 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,23.09,40,,18.47,percent of total billed charges,40% of total billed charges,21.51,46.18,
ACETYLCYSTEINE 20%,6400014,CDM,250,RC,A9270,HCPCS,Outpatient,,,57.4,45.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.92,80,,36.74,percent of total billed charges,80% of total billed charges,21.39,37.27,,17.11,percent of total billed charges,37.27% of total billed charges,21.39,37.27,,17.11,percent of total billed charges,37.27% of total billed charges,21.39,37.27,,17.11,percent of total billed charges,37.27% 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,22.96,40,,18.37,percent of total billed charges,40% of total billed charges,21.39,45.92,
NAPROSYN 500MG UD,6400014,CDM,250,RC,,,Outpatient,,,4.55,3.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.64,80,,2.91,percent of total billed charges,80% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% 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,1.82,40,,1.46,percent of total billed charges,40% of total billed charges,1.7,3.64,
COCAINE SOL 4%,6400014,CDM,250,RC,,,Outpatient,,,92.15,73.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.72,80,,58.98,percent of total billed charges,80% of total billed charges,34.34,37.27,,27.47,percent of total billed charges,37.27% of total billed charges,34.34,37.27,,27.47,percent of total billed charges,37.27% of total billed charges,34.34,37.27,,27.47,percent of total billed charges,37.27% 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,36.86,40,,29.49,percent of total billed charges,40% of total billed charges,34.34,73.72,
XYLOCAINE 1.5% W/EPI,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,30.05,24.04,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.04,80,,19.23,percent of total billed charges,80% of total billed charges,11.2,37.27,,8.96,percent of total billed charges,37.27% of total billed charges,11.2,37.27,,8.96,percent of total billed charges,37.27% of total billed charges,11.2,37.27,,8.96,percent of total billed charges,37.27% 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,12.02,40,,9.62,percent of total billed charges,40% of total billed charges,11.2,24.04,
TERAZOL-7 VAG CREAM,6400014,CDM,250,RC,,,Outpatient,,,153.6,122.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.88,80,,98.3,percent of total billed charges,80% of total billed charges,57.25,37.27,,45.8,percent of total billed charges,37.27% of total billed charges,57.25,37.27,,45.8,percent of total billed charges,37.27% of total billed charges,57.25,37.27,,45.8,percent of total billed charges,37.27% 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,61.44,40,,49.15,percent of total billed charges,40% of total billed charges,57.25,122.88,
POTASSIUM ACETATE IN,6400014,CDM,250,RC,,,Outpatient,,,17.85,14.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.28,80,,11.42,percent of total billed charges,80% of total billed charges,6.65,37.27,,5.32,percent of total billed charges,37.27% of total billed charges,6.65,37.27,,5.32,percent of total billed charges,37.27% of total billed charges,6.65,37.27,,5.32,percent of total billed charges,37.27% 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,7.14,40,,5.71,percent of total billed charges,40% of total billed charges,6.65,14.28,
TOBRADEX OPTH DROPS,6400014,CDM,250,RC,,,Outpatient,,,205.03,164.02,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.02,80,,131.22,percent of total billed charges,80% of total billed charges,76.41,37.27,,61.13,percent of total billed charges,37.27% of total billed charges,76.41,37.27,,61.13,percent of total billed charges,37.27% of total billed charges,76.41,37.27,,61.13,percent of total billed charges,37.27% 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,82.01,40,,65.61,percent of total billed charges,40% of total billed charges,76.41,164.02,
SECTRAL 400MG,6400014,CDM,250,RC,,,Outpatient,,,3.7,2.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.96,80,,2.37,percent of total billed charges,80% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% 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,1.48,40,,1.18,percent of total billed charges,40% of total billed charges,1.38,2.96,
ZANTAC 15MG/ML SYRUP,6400014,CDM,250,RC,,,Outpatient,,,87.65,70.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.12,80,,56.1,percent of total billed charges,80% of total billed charges,32.67,37.27,,26.14,percent of total billed charges,37.27% of total billed charges,32.67,37.27,,26.14,percent of total billed charges,37.27% of total billed charges,32.67,37.27,,26.14,percent of total billed charges,37.27% 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,35.06,40,,28.05,percent of total billed charges,40% of total billed charges,32.67,70.12,
GLUCERNA W/FIBER 8 O,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
SODIUM ACETATE INJ,6400014,CDM,250,RC,,,Outpatient,,,11.7,9.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.36,80,,7.49,percent of total billed charges,80% of total billed charges,4.36,37.27,,3.49,percent of total billed charges,37.27% of total billed charges,4.36,37.27,,3.49,percent of total billed charges,37.27% of total billed charges,4.36,37.27,,3.49,percent of total billed charges,37.27% 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,4.68,40,,3.74,percent of total billed charges,40% of total billed charges,4.36,9.36,
DIPYRIDAMOLE 50MG UD,6400014,CDM,250,RC,,,Outpatient,,,2.35,1.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.88,80,,1.5,percent of total billed charges,80% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% 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,0.94,40,,0.75,percent of total billed charges,40% of total billed charges,0.88,1.88,
SANTYL OINTMENT 30GM,6400014,CDM,250,RC,,,Outpatient,,,233.31,186.65,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186.65,80,,149.32,percent of total billed charges,80% of total billed charges,86.95,37.27,,69.56,percent of total billed charges,37.27% of total billed charges,86.95,37.27,,69.56,percent of total billed charges,37.27% of total billed charges,86.95,37.27,,69.56,percent of total billed charges,37.27% 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,93.32,40,,74.66,percent of total billed charges,40% of total billed charges,86.95,186.65,
SYNTHROID 0.088 MG T,6400014,CDM,250,RC,,,Outpatient,,,6.45,5.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.16,80,,4.13,percent of total billed charges,80% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% 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,2.58,40,,2.06,percent of total billed charges,40% of total billed charges,2.4,5.16,
DIPYRIDAMOLE 75MG UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ESTROPIPATE 1.25 TAB,6400014,CDM,250,RC,,,Outpatient,,,5.4,4.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.32,80,,3.46,percent of total billed charges,80% of total billed charges,2.01,37.27,,1.61,percent of total billed charges,37.27% of total billed charges,2.01,37.27,,1.61,percent of total billed charges,37.27% of total billed charges,2.01,37.27,,1.61,percent of total billed charges,37.27% 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,2.16,40,,1.73,percent of total billed charges,40% of total billed charges,2.01,4.32,
ALTACE 5MG CAP,6400014,CDM,250,RC,,,Outpatient,,,2.95,2.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,80,,1.89,percent of total billed charges,80% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% 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,1.18,40,,0.94,percent of total billed charges,40% of total billed charges,1.1,2.36,
DOXEPIN 75MG STD,6400014,CDM,250,RC,,,Outpatient,,,6.15,4.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.92,80,,3.94,percent of total billed charges,80% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% 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,2.46,40,,1.97,percent of total billed charges,40% of total billed charges,2.29,4.92,
ENSURE CHOCOLATE 8 O,6400014,CDM,250,RC,,,Outpatient,,,7.1,5.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.68,80,,4.54,percent of total billed charges,80% of total billed charges,2.65,37.27,,2.12,percent of total billed charges,37.27% of total billed charges,2.65,37.27,,2.12,percent of total billed charges,37.27% of total billed charges,2.65,37.27,,2.12,percent of total billed charges,37.27% 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,2.84,40,,2.27,percent of total billed charges,40% of total billed charges,2.65,5.68,
ENSURE STRAWBERRY 8,6400014,CDM,250,RC,,,Outpatient,,,6.6,5.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.28,80,,4.22,percent of total billed charges,80% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% 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,2.64,40,,2.11,percent of total billed charges,40% of total billed charges,2.46,5.28,
DILACOR XR 240 MG CA,6400014,CDM,250,RC,,,Outpatient,,,3.43,2.74,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.74,80,,2.19,percent of total billed charges,80% of total billed charges,1.28,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.28,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.28,37.27,,1.02,percent of total billed charges,37.27% 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,1.37,40,,1.1,percent of total billed charges,40% of total billed charges,1.28,2.74,
INDERAL LA 120 CAP,6400014,CDM,250,RC,,,Outpatient,,,14.65,11.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.72,80,,9.38,percent of total billed charges,80% of total billed charges,5.46,37.27,,4.37,percent of total billed charges,37.27% of total billed charges,5.46,37.27,,4.37,percent of total billed charges,37.27% of total billed charges,5.46,37.27,,4.37,percent of total billed charges,37.27% 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,5.86,40,,4.69,percent of total billed charges,40% of total billed charges,5.46,11.72,
PROZAC CAP 20MG U D,6400014,CDM,250,RC,,,Outpatient,,,9.35,7.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.48,80,,5.98,percent of total billed charges,80% of total billed charges,3.48,37.27,,2.78,percent of total billed charges,37.27% of total billed charges,3.48,37.27,,2.78,percent of total billed charges,37.27% of total billed charges,3.48,37.27,,2.78,percent of total billed charges,37.27% 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,3.74,40,,2.99,percent of total billed charges,40% of total billed charges,3.48,7.48,
ACTIDOSE AQUA 120 ML,6400014,CDM,250,RC,,,Outpatient,,,56.95,45.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.56,80,,36.45,percent of total billed charges,80% of total billed charges,21.23,37.27,,16.98,percent of total billed charges,37.27% of total billed charges,21.23,37.27,,16.98,percent of total billed charges,37.27% of total billed charges,21.23,37.27,,16.98,percent of total billed charges,37.27% 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,22.78,40,,18.22,percent of total billed charges,40% of total billed charges,21.23,45.56,
OCCUCOAT 1.0ML VISCO,6400014,CDM,250,RC,,,Outpatient,,,235.1,188.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.08,80,,150.46,percent of total billed charges,80% of total billed charges,87.62,37.27,,70.1,percent of total billed charges,37.27% of total billed charges,87.62,37.27,,70.1,percent of total billed charges,37.27% of total billed charges,87.62,37.27,,70.1,percent of total billed charges,37.27% 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,94.04,40,,75.23,percent of total billed charges,40% of total billed charges,87.62,188.08,
OCUFLOX OPTH SUSP 0.,6400014,CDM,250,RC,,,Outpatient,,,326.5,261.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,261.2,80,,208.96,percent of total billed charges,80% of total billed charges,121.69,37.27,,97.35,percent of total billed charges,37.27% of total billed charges,121.69,37.27,,97.35,percent of total billed charges,37.27% of total billed charges,121.69,37.27,,97.35,percent of total billed charges,37.27% 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,130.6,40,,104.48,percent of total billed charges,40% of total billed charges,121.69,261.2,
SINEMET CR 50/200 U,6400014,CDM,250,RC,,,Outpatient,,,6.25,5.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5,80,,4,percent of total billed charges,80% of total billed charges,2.33,37.27,,1.86,percent of total billed charges,37.27% of total billed charges,2.33,37.27,,1.86,percent of total billed charges,37.27% of total billed charges,2.33,37.27,,1.86,percent of total billed charges,37.27% 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,2.5,40,,2,percent of total billed charges,40% of total billed charges,2.33,5,
CEFTIN TAB 250 MG,6400014,CDM,250,RC,,,Outpatient,,,37.75,30.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.2,80,,24.16,percent of total billed charges,80% of total billed charges,14.07,37.27,,11.26,percent of total billed charges,37.27% of total billed charges,14.07,37.27,,11.26,percent of total billed charges,37.27% of total billed charges,14.07,37.27,,11.26,percent of total billed charges,37.27% 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,15.1,40,,12.08,percent of total billed charges,40% of total billed charges,14.07,30.2,
DIOVAN 80MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,37.8,30.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,80,,24.19,percent of total billed charges,80% of total billed charges,14.09,37.27,,11.27,percent of total billed charges,37.27% of total billed charges,14.09,37.27,,11.27,percent of total billed charges,37.27% of total billed charges,14.09,37.27,,11.27,percent of total billed charges,37.27% 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,15.12,40,,12.1,percent of total billed charges,40% of total billed charges,14.09,30.24,
THEOPHYLLINE 300MG T,6400014,CDM,250,RC,,,Outpatient,,,14.6,11.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.68,80,,9.34,percent of total billed charges,80% of total billed charges,5.44,37.27,,4.35,percent of total billed charges,37.27% of total billed charges,5.44,37.27,,4.35,percent of total billed charges,37.27% of total billed charges,5.44,37.27,,4.35,percent of total billed charges,37.27% 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,5.84,40,,4.67,percent of total billed charges,40% of total billed charges,5.44,11.68,
COZAAR 100MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,12.95,10.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.36,80,,8.29,percent of total billed charges,80% of total billed charges,4.83,37.27,,3.86,percent of total billed charges,37.27% of total billed charges,4.83,37.27,,3.86,percent of total billed charges,37.27% of total billed charges,4.83,37.27,,3.86,percent of total billed charges,37.27% 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,5.18,40,,4.14,percent of total billed charges,40% of total billed charges,4.83,10.36,
ACTONEL 30MB TABLET,6400014,CDM,250,RC,,,Outpatient,,,173.55,138.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.84,80,,111.07,percent of total billed charges,80% of total billed charges,64.68,37.27,,51.74,percent of total billed charges,37.27% of total billed charges,64.68,37.27,,51.74,percent of total billed charges,37.27% of total billed charges,64.68,37.27,,51.74,percent of total billed charges,37.27% 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,69.42,40,,55.54,percent of total billed charges,40% of total billed charges,64.68,138.84,
ALPHAGAN-P O.15% EYE,6400014,CDM,250,RC,,,Outpatient,,,332.85,266.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,266.28,80,,213.02,percent of total billed charges,80% of total billed charges,124.05,37.27,,99.24,percent of total billed charges,37.27% of total billed charges,124.05,37.27,,99.24,percent of total billed charges,37.27% of total billed charges,124.05,37.27,,99.24,percent of total billed charges,37.27% 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,133.14,40,,106.51,percent of total billed charges,40% of total billed charges,124.05,266.28,
NESACAINE-MPF 3% VIA,6065130,CDM,636,RC,J2401,HCPCS,Outpatient,,,92.35,73.88,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.88,80,,59.1,percent of total billed charges,80% of total billed charges,34.42,37.27,,27.54,percent of total billed charges,37.27% of total billed charges,34.42,37.27,,27.54,percent of total billed charges,37.27% of total billed charges,34.42,37.27,,27.54,percent of total billed charges,37.27% of total billed charges,0.03,100,,,fee schedule,100% of APC rate,0.03,100,,,fee schedule,100% of APC rate,0.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.03,100,,,fee schedule,100% of APC rate,0.03,100,,,fee schedule,100% of APC rate,0.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.94,40,,29.55,percent of total billed charges,40% of total billed charges,0.03,73.88,
REMINYL TAB 12 MG,6400014,CDM,250,RC,,,Outpatient,,,9.4,7.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.52,80,,6.02,percent of total billed charges,80% of total billed charges,3.5,37.27,,2.8,percent of total billed charges,37.27% of total billed charges,3.5,37.27,,2.8,percent of total billed charges,37.27% of total billed charges,3.5,37.27,,2.8,percent of total billed charges,37.27% 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,3.76,40,,3.01,percent of total billed charges,40% of total billed charges,3.5,7.52,
ICAR 15MG/1.25ML SUS,6400014,CDM,250,RC,,,Outpatient,,,49.9,39.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.92,80,,31.94,percent of total billed charges,80% of total billed charges,18.6,37.27,,14.88,percent of total billed charges,37.27% of total billed charges,18.6,37.27,,14.88,percent of total billed charges,37.27% of total billed charges,18.6,37.27,,14.88,percent of total billed charges,37.27% 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,19.96,40,,15.97,percent of total billed charges,40% of total billed charges,18.6,39.92,
AUGMENTIN XR 1000 MG,6400014,CDM,250,RC,,,Outpatient,,,16.35,13.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.08,80,,10.46,percent of total billed charges,80% of total billed charges,6.09,37.27,,4.87,percent of total billed charges,37.27% of total billed charges,6.09,37.27,,4.87,percent of total billed charges,37.27% of total billed charges,6.09,37.27,,4.87,percent of total billed charges,37.27% 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,6.54,40,,5.23,percent of total billed charges,40% of total billed charges,6.09,13.08,
FLEETS ENEMA,5880901,CDM,637,RC,,,Outpatient,,,15.9,12.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.72,80,,10.18,percent of total billed charges,80% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% 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,6.36,40,,5.09,percent of total billed charges,40% of total billed charges,5.93,12.72,
CELLCEPT 250MG CAPSU,6065130,CDM,636,RC,J7517,HCPCS,Outpatient,,,36.8,29.44,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.44,80,,23.55,percent of total billed charges,80% of total billed charges,13.72,37.27,,10.98,percent of total billed charges,37.27% of total billed charges,13.72,37.27,,10.98,percent of total billed charges,37.27% of total billed charges,13.72,37.27,,10.98,percent of total billed charges,37.27% 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,14.72,40,,11.78,percent of total billed charges,40% of total billed charges,13.72,29.44,
SPIRIVA 18MCG CP-HAN,6400014,CDM,250,RC,,,Outpatient,,,317.6,254.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,254.08,80,,203.26,percent of total billed charges,80% of total billed charges,118.37,37.27,,94.7,percent of total billed charges,37.27% of total billed charges,118.37,37.27,,94.7,percent of total billed charges,37.27% of total billed charges,118.37,37.27,,94.7,percent of total billed charges,37.27% 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,127.04,40,,101.63,percent of total billed charges,40% of total billed charges,118.37,254.08,
CITRACAL PLUS WITH M,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ALTOPREV 60MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,63.2,50.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.56,80,,40.45,percent of total billed charges,80% of total billed charges,23.55,37.27,,18.84,percent of total billed charges,37.27% of total billed charges,23.55,37.27,,18.84,percent of total billed charges,37.27% of total billed charges,23.55,37.27,,18.84,percent of total billed charges,37.27% 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,25.28,40,,20.22,percent of total billed charges,40% of total billed charges,23.55,50.56,
CRESTOR 10MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,37.7,30.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.16,80,,24.13,percent of total billed charges,80% of total billed charges,14.05,37.27,,11.24,percent of total billed charges,37.27% of total billed charges,14.05,37.27,,11.24,percent of total billed charges,37.27% of total billed charges,14.05,37.27,,11.24,percent of total billed charges,37.27% 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,15.08,40,,12.06,percent of total billed charges,40% of total billed charges,14.05,30.16,
GFN/PHENYLEPHRINE TA,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
DOPAMINE 400MG/5 ML,6065130,CDM,636,RC,J1265,HCPCS,Outpatient,,,13.45,10.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.76,80,,8.61,percent of total billed charges,80% of total billed charges,5.01,37.27,,4.01,percent of total billed charges,37.27% of total billed charges,5.01,37.27,,4.01,percent of total billed charges,37.27% of total billed charges,5.01,37.27,,4.01,percent of total billed charges,37.27% 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,5.38,40,,4.3,percent of total billed charges,40% of total billed charges,5.01,10.76,
FASLODEX 25MG/5ML S,6065130,CDM,636,RC,J9395,HCPCS,Outpatient,,,396.96,317.57,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,317.57,80,,254.06,percent of total billed charges,80% of total billed charges,147.95,37.27,,118.36,percent of total billed charges,37.27% of total billed charges,147.95,37.27,,118.36,percent of total billed charges,37.27% of total billed charges,147.95,37.27,,118.36,percent of total billed charges,37.27% of total billed charges,7.51,100,,,fee schedule,100% of APC rate,7.51,100,,,fee schedule,100% of APC rate,7.51,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,7.51,100,,,fee schedule,100% of APC rate,7.51,100,,,fee schedule,100% of APC rate,7.51,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.78,40,,127.02,percent of total billed charges,40% of total billed charges,7.51,317.57,
LUMIGAN 0.03% EYE DR,6400014,CDM,250,RC,,,Outpatient,,,338.65,270.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,270.92,80,,216.74,percent of total billed charges,80% of total billed charges,126.21,37.27,,100.97,percent of total billed charges,37.27% of total billed charges,126.21,37.27,,100.97,percent of total billed charges,37.27% of total billed charges,126.21,37.27,,100.97,percent of total billed charges,37.27% 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,135.46,40,,108.37,percent of total billed charges,40% of total billed charges,126.21,270.92,
LOVENOX 80MG PREFILL,6065130,CDM,636,RC,J1650,HCPCS,Outpatient,,,246.35,197.08,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,197.08,80,,157.66,percent of total billed charges,80% of total billed charges,91.81,37.27,,73.45,percent of total billed charges,37.27% of total billed charges,91.81,37.27,,73.45,percent of total billed charges,37.27% of total billed charges,91.81,37.27,,73.45,percent of total billed charges,37.27% 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,98.54,40,,78.83,percent of total billed charges,40% of total billed charges,91.81,197.08,
LIDOCAINE HCL 2% AMP,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,17.4,13.92,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.92,80,,11.14,percent of total billed charges,80% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% 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,6.96,40,,5.57,percent of total billed charges,40% of total billed charges,6.48,13.92,
AMIDATE 2MG/ML AMPUL,6400014,CDM,250,RC,,,Outpatient,,,69.6,55.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,80,,44.54,percent of total billed charges,80% of total billed charges,25.94,37.27,,20.75,percent of total billed charges,37.27% of total billed charges,25.94,37.27,,20.75,percent of total billed charges,37.27% of total billed charges,25.94,37.27,,20.75,percent of total billed charges,37.27% 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,27.84,40,,22.27,percent of total billed charges,40% of total billed charges,25.94,55.68,
XYLOCAINE-MPF 0.5% V,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,43.25,34.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.6,80,,27.68,percent of total billed charges,80% of total billed charges,16.12,37.27,,12.9,percent of total billed charges,37.27% of total billed charges,16.12,37.27,,12.9,percent of total billed charges,37.27% of total billed charges,16.12,37.27,,12.9,percent of total billed charges,37.27% 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,17.3,40,,13.84,percent of total billed charges,40% of total billed charges,16.12,34.6,
SARNA ANTI-ITCH LOTI,6400014,CDM,250,RC,,,Outpatient,,,27.6,22.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,80,,17.66,percent of total billed charges,80% of total billed charges,10.29,37.27,,8.23,percent of total billed charges,37.27% of total billed charges,10.29,37.27,,8.23,percent of total billed charges,37.27% of total billed charges,10.29,37.27,,8.23,percent of total billed charges,37.27% 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,11.04,40,,8.83,percent of total billed charges,40% of total billed charges,10.29,22.08,
TRICOR 160 MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,13.55,10.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.84,80,,8.67,percent of total billed charges,80% of total billed charges,5.05,37.27,,4.04,percent of total billed charges,37.27% of total billed charges,5.05,37.27,,4.04,percent of total billed charges,37.27% of total billed charges,5.05,37.27,,4.04,percent of total billed charges,37.27% 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,5.42,40,,4.34,percent of total billed charges,40% of total billed charges,5.05,10.84,
LAMICTAL 100MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,20,16.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
HEMOCYTE PLUS TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
VISICOL TABLET,6400014,CDM,250,RC,,,Outpatient,,,15.6,12.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,80,,9.98,percent of total billed charges,80% of total billed charges,5.81,37.27,,4.65,percent of total billed charges,37.27% of total billed charges,5.81,37.27,,4.65,percent of total billed charges,37.27% of total billed charges,5.81,37.27,,4.65,percent of total billed charges,37.27% 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,6.24,40,,4.99,percent of total billed charges,40% of total billed charges,5.81,12.48,
TRAZODONE 150MG TABL,6400014,CDM,250,RC,,,Outpatient,,,9.5,7.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.6,80,,6.08,percent of total billed charges,80% of total billed charges,3.54,37.27,,2.83,percent of total billed charges,37.27% of total billed charges,3.54,37.27,,2.83,percent of total billed charges,37.27% of total billed charges,3.54,37.27,,2.83,percent of total billed charges,37.27% 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,3.8,40,,3.04,percent of total billed charges,40% of total billed charges,3.54,7.6,
INDIA INK 1:100 SOLN,6400014,CDM,250,RC,,,Outpatient,,,123.75,99.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99,80,,79.2,percent of total billed charges,80% of total billed charges,46.12,37.27,,36.9,percent of total billed charges,37.27% of total billed charges,46.12,37.27,,36.9,percent of total billed charges,37.27% of total billed charges,46.12,37.27,,36.9,percent of total billed charges,37.27% 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,49.5,40,,39.6,percent of total billed charges,40% of total billed charges,46.12,99,
PREVACID SUSPENSION,6400014,CDM,250,RC,,,Outpatient,,,18.95,15.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.16,80,,12.13,percent of total billed charges,80% of total billed charges,7.06,37.27,,5.65,percent of total billed charges,37.27% of total billed charges,7.06,37.27,,5.65,percent of total billed charges,37.27% of total billed charges,7.06,37.27,,5.65,percent of total billed charges,37.27% 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,7.58,40,,6.06,percent of total billed charges,40% of total billed charges,7.06,15.16,
CENTRUM SILVER TABLE,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
HEMOCYTE-F ELIXIR (O,6400014,CDM,250,RC,,,Outpatient,,,10.98,8.78,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.78,80,,7.02,percent of total billed charges,80% of total billed charges,4.09,37.27,,3.27,percent of total billed charges,37.27% of total billed charges,4.09,37.27,,3.27,percent of total billed charges,37.27% of total billed charges,4.09,37.27,,3.27,percent of total billed charges,37.27% 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,4.39,40,,3.51,percent of total billed charges,40% of total billed charges,4.09,8.78,
LEXAPRO 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,18.2,14.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.56,80,,11.65,percent of total billed charges,80% of total billed charges,6.78,37.27,,5.42,percent of total billed charges,37.27% of total billed charges,6.78,37.27,,5.42,percent of total billed charges,37.27% of total billed charges,6.78,37.27,,5.42,percent of total billed charges,37.27% 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,7.28,40,,5.82,percent of total billed charges,40% of total billed charges,6.78,14.56,
GEODON INJ 20MG/ML,6065130,CDM,636,RC,J3486,HCPCS,Outpatient,,,213.2,170.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170.56,80,,136.45,percent of total billed charges,80% of total billed charges,79.46,37.27,,63.57,percent of total billed charges,37.27% of total billed charges,79.46,37.27,,63.57,percent of total billed charges,37.27% of total billed charges,79.46,37.27,,63.57,percent of total billed charges,37.27% 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,85.28,40,,68.22,percent of total billed charges,40% of total billed charges,79.46,170.56,
PAMINE 2.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,12.35,9.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.88,80,,7.9,percent of total billed charges,80% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% 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,4.94,40,,3.95,percent of total billed charges,40% of total billed charges,4.6,9.88,
GABIRTIL 4MG TAB,6400014,CDM,250,RC,,,Outpatient,,,25.25,20.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.2,80,,16.16,percent of total billed charges,80% of total billed charges,9.41,37.27,,7.53,percent of total billed charges,37.27% of total billed charges,9.41,37.27,,7.53,percent of total billed charges,37.27% of total billed charges,9.41,37.27,,7.53,percent of total billed charges,37.27% 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,10.1,40,,8.08,percent of total billed charges,40% of total billed charges,9.41,20.2,
HUMALOG MIX 75/25 VI,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,122.95,98.36,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.36,80,,78.69,percent of total billed charges,80% of total billed charges,45.82,37.27,,36.66,percent of total billed charges,37.27% of total billed charges,45.82,37.27,,36.66,percent of total billed charges,37.27% of total billed charges,45.82,37.27,,36.66,percent of total billed charges,37.27% 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,49.18,40,,39.34,percent of total billed charges,40% of total billed charges,45.82,98.36,
CLARITIN-D 24 HOUR T,6400014,CDM,250,RC,,,Outpatient,,,4.52,3.62,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.62,80,,2.9,percent of total billed charges,80% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% 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,1.81,40,,1.45,percent of total billed charges,40% of total billed charges,1.68,3.62,
ABILIFY 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,103.45,82.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.76,80,,66.21,percent of total billed charges,80% of total billed charges,38.56,37.27,,30.85,percent of total billed charges,37.27% of total billed charges,38.56,37.27,,30.85,percent of total billed charges,37.27% of total billed charges,38.56,37.27,,30.85,percent of total billed charges,37.27% 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,41.38,40,,33.1,percent of total billed charges,40% of total billed charges,38.56,82.76,
ABILIFY 15MG TAB,6400014,CDM,250,RC,,,Outpatient,,,68.5,54.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.8,80,,43.84,percent of total billed charges,80% of total billed charges,25.53,37.27,,20.42,percent of total billed charges,37.27% of total billed charges,25.53,37.27,,20.42,percent of total billed charges,37.27% of total billed charges,25.53,37.27,,20.42,percent of total billed charges,37.27% 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,27.4,40,,21.92,percent of total billed charges,40% of total billed charges,25.53,54.8,
POLY-TUSSIN XP EXPEC,6400014,CDM,250,RC,,,Outpatient,,,16.3,13.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.04,80,,10.43,percent of total billed charges,80% of total billed charges,6.08,37.27,,4.86,percent of total billed charges,37.27% of total billed charges,6.08,37.27,,4.86,percent of total billed charges,37.27% of total billed charges,6.08,37.27,,4.86,percent of total billed charges,37.27% 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,6.52,40,,5.22,percent of total billed charges,40% of total billed charges,6.08,13.04,
PROVIGIL 200MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,147.8,118.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.24,80,,94.59,percent of total billed charges,80% of total billed charges,55.09,37.27,,44.07,percent of total billed charges,37.27% of total billed charges,55.09,37.27,,44.07,percent of total billed charges,37.27% of total billed charges,55.09,37.27,,44.07,percent of total billed charges,37.27% 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,59.12,40,,47.3,percent of total billed charges,40% of total billed charges,55.09,118.24,
PROVIGIL 100MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,14.26,11.41,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.41,80,,9.13,percent of total billed charges,80% of total billed charges,5.31,37.27,,4.25,percent of total billed charges,37.27% of total billed charges,5.31,37.27,,4.25,percent of total billed charges,37.27% of total billed charges,5.31,37.27,,4.25,percent of total billed charges,37.27% 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,5.7,40,,4.56,percent of total billed charges,40% of total billed charges,5.31,11.41,
CHIROCAINE EPIDURAL,6400014,CDM,250,RC,,,Outpatient,,,155,124.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% 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,62,40,,49.6,percent of total billed charges,40% of total billed charges,57.77,124,
CHIROCAINE 2.5MG/ML,6400014,CDM,250,RC,,,Outpatient,,,29.55,23.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.64,80,,18.91,percent of total billed charges,80% of total billed charges,11.01,37.27,,8.81,percent of total billed charges,37.27% of total billed charges,11.01,37.27,,8.81,percent of total billed charges,37.27% of total billed charges,11.01,37.27,,8.81,percent of total billed charges,37.27% 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,11.82,40,,9.46,percent of total billed charges,40% of total billed charges,11.01,23.64,
MS CONTIN 60MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,22.5,18.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18,80,,14.4,percent of total billed charges,80% of total billed charges,8.39,37.27,,6.71,percent of total billed charges,37.27% of total billed charges,8.39,37.27,,6.71,percent of total billed charges,37.27% of total billed charges,8.39,37.27,,6.71,percent of total billed charges,37.27% 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,9,40,,7.2,percent of total billed charges,40% of total billed charges,8.39,18,
ZETIA 10MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,47.05,37.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.64,80,,30.11,percent of total billed charges,80% of total billed charges,17.54,37.27,,14.03,percent of total billed charges,37.27% of total billed charges,17.54,37.27,,14.03,percent of total billed charges,37.27% of total billed charges,17.54,37.27,,14.03,percent of total billed charges,37.27% 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,18.82,40,,15.06,percent of total billed charges,40% of total billed charges,17.54,37.64,
ZYVOX 600MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,740.8,592.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,592.64,80,,474.11,percent of total billed charges,80% of total billed charges,276.1,37.27,,220.88,percent of total billed charges,37.27% of total billed charges,276.1,37.27,,220.88,percent of total billed charges,37.27% of total billed charges,276.1,37.27,,220.88,percent of total billed charges,37.27% 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,296.32,40,,237.06,percent of total billed charges,40% of total billed charges,276.1,592.64,
DIFLUCAN 40MG/ML SUS,6400014,CDM,250,RC,,,Outpatient,,,677.55,542.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,542.04,80,,433.63,percent of total billed charges,80% of total billed charges,252.52,37.27,,202.02,percent of total billed charges,37.27% of total billed charges,252.52,37.27,,202.02,percent of total billed charges,37.27% of total billed charges,252.52,37.27,,202.02,percent of total billed charges,37.27% 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,271.02,40,,216.82,percent of total billed charges,40% of total billed charges,252.52,542.04,
LEVAQUIN 500MG/100ML,6065130,CDM,636,RC,J1956,HCPCS,Outpatient,,,150.65,120.52,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.52,80,,96.42,percent of total billed charges,80% of total billed charges,56.15,37.27,,44.92,percent of total billed charges,37.27% of total billed charges,56.15,37.27,,44.92,percent of total billed charges,37.27% of total billed charges,56.15,37.27,,44.92,percent of total billed charges,37.27% 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,60.26,40,,48.21,percent of total billed charges,40% of total billed charges,56.15,120.52,
ZYVOX 600MG/300ML IV,6065130,CDM,636,RC,J2020,HCPCS,Outpatient,,,156.32,125.06,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.06,80,,100.05,percent of total billed charges,80% of total billed charges,58.26,37.27,,46.61,percent of total billed charges,37.27% of total billed charges,58.26,37.27,,46.61,percent of total billed charges,37.27% of total billed charges,58.26,37.27,,46.61,percent of total billed charges,37.27% 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,62.53,40,,50.02,percent of total billed charges,40% of total billed charges,58.26,125.06,
ZOCOR 20MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,15.15,12.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.12,80,,9.7,percent of total billed charges,80% of total billed charges,5.65,37.27,,4.52,percent of total billed charges,37.27% of total billed charges,5.65,37.27,,4.52,percent of total billed charges,37.27% of total billed charges,5.65,37.27,,4.52,percent of total billed charges,37.27% 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,6.06,40,,4.85,percent of total billed charges,40% of total billed charges,5.65,12.12,
ZITHROMAX 200MG/5ML,6400014,CDM,250,RC,,,Outpatient,,,224.6,179.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.68,80,,143.74,percent of total billed charges,80% of total billed charges,83.71,37.27,,66.97,percent of total billed charges,37.27% of total billed charges,83.71,37.27,,66.97,percent of total billed charges,37.27% of total billed charges,83.71,37.27,,66.97,percent of total billed charges,37.27% 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,89.84,40,,71.87,percent of total billed charges,40% of total billed charges,83.71,179.68,
DITROPAN XL 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,14.65,11.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.72,80,,9.38,percent of total billed charges,80% of total billed charges,5.46,37.27,,4.37,percent of total billed charges,37.27% of total billed charges,5.46,37.27,,4.37,percent of total billed charges,37.27% of total billed charges,5.46,37.27,,4.37,percent of total billed charges,37.27% 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,5.86,40,,4.69,percent of total billed charges,40% of total billed charges,5.46,11.72,
ACTHIB VACCINE VIAL,6400014,CDM,250,RC,,,Outpatient,,,89.86,71.89,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.89,80,,57.51,percent of total billed charges,80% of total billed charges,33.49,37.27,,26.79,percent of total billed charges,37.27% of total billed charges,33.49,37.27,,26.79,percent of total billed charges,37.27% of total billed charges,33.49,37.27,,26.79,percent of total billed charges,37.27% 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,35.94,40,,28.75,percent of total billed charges,40% of total billed charges,33.49,71.89,
ARANESP 200INJ(PER5),6065130,CDM,636,RC,J0881,HCPCS,Outpatient,,,65.78,52.62,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.62,80,,42.1,percent of total billed charges,80% of total billed charges,24.52,37.27,,19.62,percent of total billed charges,37.27% of total billed charges,24.52,37.27,,19.62,percent of total billed charges,37.27% of total billed charges,24.52,37.27,,19.62,percent of total billed charges,37.27% of total billed charges,3.04,100,,,fee schedule,100% of APC rate,3.04,100,,,fee schedule,100% of APC rate,3.04,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,3.04,100,,,fee schedule,100% of APC rate,3.04,100,,,fee schedule,100% of APC rate,3.04,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.31,40,,21.05,percent of total billed charges,40% of total billed charges,3.04,52.62,
LEVAQUIN 750MG/150ML,6065130,CDM,636,RC,J1956,HCPCS,Outpatient,,,199.9,159.92,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.92,80,,127.94,percent of total billed charges,80% of total billed charges,74.5,37.27,,59.6,percent of total billed charges,37.27% of total billed charges,74.5,37.27,,59.6,percent of total billed charges,37.27% of total billed charges,74.5,37.27,,59.6,percent of total billed charges,37.27% 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,79.96,40,,63.97,percent of total billed charges,40% of total billed charges,74.5,159.92,
TUSSIONEX PENNKINETI,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
ZYMAR 0.3% EYE DROPS,6400014,CDM,250,RC,,,Outpatient,,,90,72.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% 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,36,40,,28.8,percent of total billed charges,40% of total billed charges,33.54,72,
LEXAPRO 20MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,7.96,6.37,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.37,80,,5.1,percent of total billed charges,80% of total billed charges,2.97,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.97,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.97,37.27,,2.38,percent of total billed charges,37.27% 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,3.18,40,,2.54,percent of total billed charges,40% of total billed charges,2.97,6.37,
FLEXTRA-650 TABLET,6400014,CDM,250,RC,,,Outpatient,,,2.2,1.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,80,,1.41,percent of total billed charges,80% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% 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,0.88,40,,0.7,percent of total billed charges,40% of total billed charges,0.82,1.76,
XOPENEX 1.25MG/3ML S,6400014,CDM,250,RC,J7614,HCPCS,Outpatient,,,25.35,20.28,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.28,80,,16.22,percent of total billed charges,80% of total billed charges,9.45,37.27,,7.56,percent of total billed charges,37.27% of total billed charges,9.45,37.27,,7.56,percent of total billed charges,37.27% of total billed charges,9.45,37.27,,7.56,percent of total billed charges,37.27% 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,10.14,40,,8.11,percent of total billed charges,40% of total billed charges,9.45,20.28,
NAMENDA 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,30.3,24.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.24,80,,19.39,percent of total billed charges,80% of total billed charges,11.29,37.27,,9.03,percent of total billed charges,37.27% of total billed charges,11.29,37.27,,9.03,percent of total billed charges,37.27% of total billed charges,11.29,37.27,,9.03,percent of total billed charges,37.27% 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,12.12,40,,9.7,percent of total billed charges,40% of total billed charges,11.29,24.24,
SSD CREAM 20GM,6400014,CDM,250,RC,,,Outpatient,,,34.05,27.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.24,80,,21.79,percent of total billed charges,80% of total billed charges,12.69,37.27,,10.15,percent of total billed charges,37.27% of total billed charges,12.69,37.27,,10.15,percent of total billed charges,37.27% of total billed charges,12.69,37.27,,10.15,percent of total billed charges,37.27% 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,13.62,40,,10.9,percent of total billed charges,40% of total billed charges,12.69,27.24,
NAROPIN EPIDURAL 1MG,6065130,CDM,636,RC,J2795,HCPCS,Outpatient,,,155,124.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% 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,62,40,,49.6,percent of total billed charges,40% of total billed charges,57.77,124,
NAROPIN 2MG/ML 10ML,6065130,CDM,636,RC,J2795,HCPCS,Outpatient,,,22.55,18.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.04,80,,14.43,percent of total billed charges,80% of total billed charges,8.4,37.27,,6.72,percent of total billed charges,37.27% of total billed charges,8.4,37.27,,6.72,percent of total billed charges,37.27% of total billed charges,8.4,37.27,,6.72,percent of total billed charges,37.27% 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,9.02,40,,7.22,percent of total billed charges,40% of total billed charges,8.4,18.04,
OPTIVAR 0.05% DROPS,6400014,CDM,250,RC,,,Outpatient,,,506.9,405.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.52,80,,324.42,percent of total billed charges,80% of total billed charges,188.92,37.27,,151.14,percent of total billed charges,37.27% of total billed charges,188.92,37.27,,151.14,percent of total billed charges,37.27% of total billed charges,188.92,37.27,,151.14,percent of total billed charges,37.27% 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,202.76,40,,162.21,percent of total billed charges,40% of total billed charges,188.92,405.52,
ZELNORM 2MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,12.6,10.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,80,,8.06,percent of total billed charges,80% of total billed charges,4.7,37.27,,3.76,percent of total billed charges,37.27% of total billed charges,4.7,37.27,,3.76,percent of total billed charges,37.27% of total billed charges,4.7,37.27,,3.76,percent of total billed charges,37.27% 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,5.04,40,,4.03,percent of total billed charges,40% of total billed charges,4.7,10.08,
MAVIK 4MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,4.9,3.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.92,80,,3.14,percent of total billed charges,80% of total billed charges,1.83,37.27,,1.46,percent of total billed charges,37.27% of total billed charges,1.83,37.27,,1.46,percent of total billed charges,37.27% of total billed charges,1.83,37.27,,1.46,percent of total billed charges,37.27% 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,1.96,40,,1.57,percent of total billed charges,40% of total billed charges,1.83,3.92,
MAVIK 1MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,7.55,6.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.04,80,,4.83,percent of total billed charges,80% of total billed charges,2.81,37.27,,2.25,percent of total billed charges,37.27% of total billed charges,2.81,37.27,,2.25,percent of total billed charges,37.27% of total billed charges,2.81,37.27,,2.25,percent of total billed charges,37.27% 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,3.02,40,,2.42,percent of total billed charges,40% of total billed charges,2.81,6.04,
PANAFIL OINTMENT,6400014,CDM,250,RC,,,Outpatient,,,290.4,232.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,232.32,80,,185.86,percent of total billed charges,80% of total billed charges,108.23,37.27,,86.58,percent of total billed charges,37.27% of total billed charges,108.23,37.27,,86.58,percent of total billed charges,37.27% of total billed charges,108.23,37.27,,86.58,percent of total billed charges,37.27% 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,116.16,40,,92.93,percent of total billed charges,40% of total billed charges,108.23,232.32,
XENADERM OINTMENT,6400014,CDM,250,RC,,,Outpatient,,,188.53,150.82,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.82,80,,120.66,percent of total billed charges,80% of total billed charges,70.27,37.27,,56.22,percent of total billed charges,37.27% of total billed charges,70.27,37.27,,56.22,percent of total billed charges,37.27% of total billed charges,70.27,37.27,,56.22,percent of total billed charges,37.27% 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,75.41,40,,60.33,percent of total billed charges,40% of total billed charges,70.27,150.82,
ZYVOX 100MG/5ML SUSP,6400014,CDM,250,RC,,,Outpatient,,,2058.1,1646.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1646.48,80,,1317.18,percent of total billed charges,80% of total billed charges,767.05,37.27,,613.64,percent of total billed charges,37.27% of total billed charges,767.05,37.27,,613.64,percent of total billed charges,37.27% of total billed charges,767.05,37.27,,613.64,percent of total billed charges,37.27% 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,823.24,40,,658.59,percent of total billed charges,40% of total billed charges,767.05,1646.48,
STERILE TALC POWDER,6400014,CDM,250,RC,,,Outpatient,,,297,237.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,237.6,80,,190.08,percent of total billed charges,80% of total billed charges,110.69,37.27,,88.55,percent of total billed charges,37.27% of total billed charges,110.69,37.27,,88.55,percent of total billed charges,37.27% of total billed charges,110.69,37.27,,88.55,percent of total billed charges,37.27% 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,118.8,40,,95.04,percent of total billed charges,40% of total billed charges,110.69,237.6,
ICAR-C PLUS SR CAPSU,6400014,CDM,250,RC,,,Outpatient,,,2.1,1.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,80,,1.34,percent of total billed charges,80% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% 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,0.84,40,,0.67,percent of total billed charges,40% of total billed charges,0.78,1.68,
FOSINOPRIL 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,4,3.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
HUMULIN U,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
SINGULAIR TAB 10 MG,6400014,CDM,250,RC,,,Outpatient,,,21.4,17.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.12,80,,13.7,percent of total billed charges,80% of total billed charges,7.98,37.27,,6.38,percent of total billed charges,37.27% of total billed charges,7.98,37.27,,6.38,percent of total billed charges,37.27% of total billed charges,7.98,37.27,,6.38,percent of total billed charges,37.27% 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,8.56,40,,6.85,percent of total billed charges,40% of total billed charges,7.98,17.12,
UNIVASC 15MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,8.85,7.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.08,80,,5.66,percent of total billed charges,80% of total billed charges,3.3,37.27,,2.64,percent of total billed charges,37.27% of total billed charges,3.3,37.27,,2.64,percent of total billed charges,37.27% of total billed charges,3.3,37.27,,2.64,percent of total billed charges,37.27% 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,3.54,40,,2.83,percent of total billed charges,40% of total billed charges,3.3,7.08,
ACIPHEX 20MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,28.3,22.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.64,80,,18.11,percent of total billed charges,80% of total billed charges,10.55,37.27,,8.44,percent of total billed charges,37.27% of total billed charges,10.55,37.27,,8.44,percent of total billed charges,37.27% of total billed charges,10.55,37.27,,8.44,percent of total billed charges,37.27% 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,11.32,40,,9.06,percent of total billed charges,40% of total billed charges,10.55,22.64,
NS 50 ML,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
AMOXICILLIN 875MG TA,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
LACTAID TABLETS,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ENSURE 1 8OZ CAN,6400014,CDM,250,RC,,,Outpatient,,,6.8,5.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,80,,4.35,percent of total billed charges,80% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% 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,2.72,40,,2.18,percent of total billed charges,40% of total billed charges,2.53,5.44,
ENSURE PLUS 8OZ,6400014,CDM,250,RC,,,Outpatient,,,7.35,5.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.88,80,,4.7,percent of total billed charges,80% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% 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,2.94,40,,2.35,percent of total billed charges,40% of total billed charges,2.74,5.88,
NASACORT INHALER,6400014,CDM,250,RC,,,Outpatient,,,108,86.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% 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,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,40.25,86.4,
ISOCAL 8OZ,6400014,CDM,250,RC,,,Outpatient,,,7.7,6.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.16,80,,4.93,percent of total billed charges,80% of total billed charges,2.87,37.27,,2.3,percent of total billed charges,37.27% of total billed charges,2.87,37.27,,2.3,percent of total billed charges,37.27% of total billed charges,2.87,37.27,,2.3,percent of total billed charges,37.27% 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,3.08,40,,2.46,percent of total billed charges,40% of total billed charges,2.87,6.16,
PEDIALYTE 8 OZ,6400014,CDM,250,RC,,,Outpatient,,,4.6,3.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.68,80,,2.94,percent of total billed charges,80% of total billed charges,1.71,37.27,,1.37,percent of total billed charges,37.27% of total billed charges,1.71,37.27,,1.37,percent of total billed charges,37.27% of total billed charges,1.71,37.27,,1.37,percent of total billed charges,37.27% 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,1.84,40,,1.47,percent of total billed charges,40% of total billed charges,1.71,3.68,
VIT B-12 100MCG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SUSTACAL 8 OZ,6400014,CDM,250,RC,,,Outpatient,,,4.6,3.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.68,80,,2.94,percent of total billed charges,80% of total billed charges,1.71,37.27,,1.37,percent of total billed charges,37.27% of total billed charges,1.71,37.27,,1.37,percent of total billed charges,37.27% of total billed charges,1.71,37.27,,1.37,percent of total billed charges,37.27% 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,1.84,40,,1.47,percent of total billed charges,40% of total billed charges,1.71,3.68,
DEPAKOTE ER 500MG TA,6400014,CDM,250,RC,,,Outpatient,,,13.5,10.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,80,,8.64,percent of total billed charges,80% of total billed charges,5.03,37.27,,4.02,percent of total billed charges,37.27% of total billed charges,5.03,37.27,,4.02,percent of total billed charges,37.27% of total billed charges,5.03,37.27,,4.02,percent of total billed charges,37.27% 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,5.4,40,,4.32,percent of total billed charges,40% of total billed charges,5.03,10.8,
VANCOMYCIN 250MG CAP,6400014,CDM,250,RC,,,Outpatient,,,251,200.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,93.55,37.27,,74.84,percent of total billed charges,37.27% of total billed charges,93.55,37.27,,74.84,percent of total billed charges,37.27% of total billed charges,93.55,37.27,,74.84,percent of total billed charges,37.27% 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,100.4,40,,80.32,percent of total billed charges,40% of total billed charges,93.55,200.8,
PLENDIL 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,5.65,4.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.52,80,,3.62,percent of total billed charges,80% of total billed charges,2.11,37.27,,1.69,percent of total billed charges,37.27% of total billed charges,2.11,37.27,,1.69,percent of total billed charges,37.27% of total billed charges,2.11,37.27,,1.69,percent of total billed charges,37.27% 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,2.26,40,,1.81,percent of total billed charges,40% of total billed charges,2.11,4.52,
PULMOCARE 8 OZ,6400014,CDM,250,RC,,,Outpatient,,,8.95,7.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.16,80,,5.73,percent of total billed charges,80% of total billed charges,3.34,37.27,,2.67,percent of total billed charges,37.27% of total billed charges,3.34,37.27,,2.67,percent of total billed charges,37.27% of total billed charges,3.34,37.27,,2.67,percent of total billed charges,37.27% 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,3.58,40,,2.86,percent of total billed charges,40% of total billed charges,3.34,7.16,
DEMEROL TAB 50MG,6400014,CDM,250,RC,,,Outpatient,,,2.83,2.26,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.26,80,,1.81,percent of total billed charges,80% of total billed charges,1.05,37.27,,0.84,percent of total billed charges,37.27% of total billed charges,1.05,37.27,,0.84,percent of total billed charges,37.27% of total billed charges,1.05,37.27,,0.84,percent of total billed charges,37.27% 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,1.13,40,,0.9,percent of total billed charges,40% of total billed charges,1.05,2.26,
HYDROMORPHONE 2MG/ML,6065130,CDM,636,RC,J1171,HCPCS,Outpatient,,,17.65,14.12,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.12,80,,11.3,percent of total billed charges,80% of total billed charges,6.58,37.27,,5.26,percent of total billed charges,37.27% of total billed charges,6.58,37.27,,5.26,percent of total billed charges,37.27% of total billed charges,6.58,37.27,,5.26,percent of total billed charges,37.27% 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,7.06,40,,5.65,percent of total billed charges,40% of total billed charges,6.58,14.12,
DILAUDID 2MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
LUGOL'S SOLUTION,5880901,CDM,637,RC,,,Outpatient,,,14.4,11.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,80,,9.22,percent of total billed charges,80% of total billed charges,5.37,37.27,,4.3,percent of total billed charges,37.27% of total billed charges,5.37,37.27,,4.3,percent of total billed charges,37.27% of total billed charges,5.37,37.27,,4.3,percent of total billed charges,37.27% 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,5.76,40,,4.61,percent of total billed charges,40% of total billed charges,5.37,11.52,
ATIVAN 2 MG INJ,6065130,CDM,636,RC,J2060,HCPCS,Outpatient,,,41.7,33.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.36,80,,26.69,percent of total billed charges,80% of total billed charges,15.54,37.27,,12.43,percent of total billed charges,37.27% of total billed charges,15.54,37.27,,12.43,percent of total billed charges,37.27% of total billed charges,15.54,37.27,,12.43,percent of total billed charges,37.27% 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,16.68,40,,13.34,percent of total billed charges,40% of total billed charges,15.54,33.36,
MEPERGAN FORTIS CAPS,6400014,CDM,250,RC,,,Outpatient,,,2.35,1.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.88,80,,1.5,percent of total billed charges,80% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% 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,0.94,40,,0.75,percent of total billed charges,40% of total billed charges,0.88,1.88,
DEMEROL 100MG CARPUJ,6065130,CDM,636,RC,J2175,HCPCS,Outpatient,,,15.8,12.64,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.64,80,,10.11,percent of total billed charges,80% of total billed charges,5.89,37.27,,4.71,percent of total billed charges,37.27% of total billed charges,5.89,37.27,,4.71,percent of total billed charges,37.27% of total billed charges,5.89,37.27,,4.71,percent of total billed charges,37.27% 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,6.32,40,,5.06,percent of total billed charges,40% of total billed charges,5.89,12.64,
DEMEROL 25MG CARPUJE,5880901,CDM,637,RC,,,Outpatient,,,24.7,19.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.76,80,,15.81,percent of total billed charges,80% of total billed charges,9.21,37.27,,7.37,percent of total billed charges,37.27% of total billed charges,9.21,37.27,,7.37,percent of total billed charges,37.27% of total billed charges,9.21,37.27,,7.37,percent of total billed charges,37.27% 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,9.88,40,,7.9,percent of total billed charges,40% of total billed charges,9.21,19.76,
DEMEROL 50MG CARPUJE,6065130,CDM,636,RC,J2175,HCPCS,Outpatient,,,30.9,24.72,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.72,80,,19.78,percent of total billed charges,80% of total billed charges,11.52,37.27,,9.22,percent of total billed charges,37.27% of total billed charges,11.52,37.27,,9.22,percent of total billed charges,37.27% of total billed charges,11.52,37.27,,9.22,percent of total billed charges,37.27% 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,12.36,40,,9.89,percent of total billed charges,40% of total billed charges,11.52,24.72,
DEMEROL 75MG CARPUJE,5880901,CDM,637,RC,,,Outpatient,,,26.15,20.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.92,80,,16.74,percent of total billed charges,80% of total billed charges,9.75,37.27,,7.8,percent of total billed charges,37.27% of total billed charges,9.75,37.27,,7.8,percent of total billed charges,37.27% of total billed charges,9.75,37.27,,7.8,percent of total billed charges,37.27% 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,10.46,40,,8.37,percent of total billed charges,40% of total billed charges,9.75,20.92,
MORPHINE SOL 10MG PE,6065130,CDM,636,RC,J2270,HCPCS,Outpatient,,,8.35,6.68,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.68,80,,5.34,percent of total billed charges,80% of total billed charges,3.11,37.27,,2.49,percent of total billed charges,37.27% of total billed charges,3.11,37.27,,2.49,percent of total billed charges,37.27% of total billed charges,3.11,37.27,,2.49,percent of total billed charges,37.27% 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,3.34,40,,2.67,percent of total billed charges,40% of total billed charges,3.11,6.68,
CARDIZEM CD 240MG,6400014,CDM,250,RC,,,Outpatient,,,6.75,5.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,80,,4.32,percent of total billed charges,80% of total billed charges,2.52,37.27,,2.02,percent of total billed charges,37.27% of total billed charges,2.52,37.27,,2.02,percent of total billed charges,37.27% of total billed charges,2.52,37.27,,2.02,percent of total billed charges,37.27% 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,2.7,40,,2.16,percent of total billed charges,40% of total billed charges,2.52,5.4,
AEROBID INHALER 7GM,6400014,CDM,250,RC,,,Outpatient,,,255.85,204.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.68,80,,163.74,percent of total billed charges,80% of total billed charges,95.36,37.27,,76.29,percent of total billed charges,37.27% of total billed charges,95.36,37.27,,76.29,percent of total billed charges,37.27% of total billed charges,95.36,37.27,,76.29,percent of total billed charges,37.27% 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,102.34,40,,81.87,percent of total billed charges,40% of total billed charges,95.36,204.68,
LUPRON DEPOT 3.75MG,6065130,CDM,636,RC,J1950,HCPCS,Outpatient,,,4734.35,3787.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3787.48,80,,3029.98,percent of total billed charges,80% of total billed charges,1764.49,37.27,,1411.59,percent of total billed charges,37.27% of total billed charges,1764.49,37.27,,1411.59,percent of total billed charges,37.27% of total billed charges,1764.49,37.27,,1411.59,percent of total billed charges,37.27% of total billed charges,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1893.74,40,,1514.99,percent of total billed charges,40% of total billed charges,1617.65,3787.48,
AUGMENTIN 600-42.9 S,6400014,CDM,250,RC,,,Outpatient,,,167.4,133.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.92,80,,107.14,percent of total billed charges,80% of total billed charges,62.39,37.27,,49.91,percent of total billed charges,37.27% of total billed charges,62.39,37.27,,49.91,percent of total billed charges,37.27% of total billed charges,62.39,37.27,,49.91,percent of total billed charges,37.27% 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,66.96,40,,53.57,percent of total billed charges,40% of total billed charges,62.39,133.92,
PERCOCET-5 TAB,6400014,CDM,250,RC,,,Outpatient,,,5.35,4.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.28,80,,3.42,percent of total billed charges,80% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% 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,2.14,40,,1.71,percent of total billed charges,40% of total billed charges,1.99,4.28,
PERCODAN TAB,6400014,CDM,250,RC,,,Outpatient,,,4,3.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
TYLENOL EX ST LIQ 50,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
RITALIN 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
XIGRIS 5MG/5ML VIAL,6400014,CDM,250,RC,,,Outpatient,,,1252.8,1002.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1002.24,80,,801.79,percent of total billed charges,80% of total billed charges,466.92,37.27,,373.54,percent of total billed charges,37.27% of total billed charges,466.92,37.27,,373.54,percent of total billed charges,37.27% of total billed charges,466.92,37.27,,373.54,percent of total billed charges,37.27% 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,501.12,40,,400.9,percent of total billed charges,40% of total billed charges,466.92,1002.24,
PROAMATINE 5MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,8.2,6.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.56,80,,5.25,percent of total billed charges,80% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% 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,3.28,40,,2.62,percent of total billed charges,40% of total billed charges,3.06,6.56,
NEORAL 100MG CAP,6065130,CDM,636,RC,J7502,HCPCS,Outpatient,,,25.3,20.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.24,80,,16.19,percent of total billed charges,80% of total billed charges,9.43,37.27,,7.54,percent of total billed charges,37.27% of total billed charges,9.43,37.27,,7.54,percent of total billed charges,37.27% of total billed charges,9.43,37.27,,7.54,percent of total billed charges,37.27% 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,10.12,40,,8.1,percent of total billed charges,40% of total billed charges,9.43,20.24,
SPIRONOLACTONE 25MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
AMIODARONE 900MG/18M,6065130,CDM,636,RC,J0282,HCPCS,Outpatient,,,13.95,11.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.16,80,,8.93,percent of total billed charges,80% of total billed charges,5.2,37.27,,4.16,percent of total billed charges,37.27% of total billed charges,5.2,37.27,,4.16,percent of total billed charges,37.27% of total billed charges,5.2,37.27,,4.16,percent of total billed charges,37.27% 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,5.58,40,,4.46,percent of total billed charges,40% of total billed charges,5.2,11.16,
AMICAR TAB 500MG,6400014,CDM,250,RC,,,Outpatient,,,11.45,9.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.16,80,,7.33,percent of total billed charges,80% of total billed charges,4.27,37.27,,3.42,percent of total billed charges,37.27% of total billed charges,4.27,37.27,,3.42,percent of total billed charges,37.27% of total billed charges,4.27,37.27,,3.42,percent of total billed charges,37.27% 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,4.58,40,,3.66,percent of total billed charges,40% of total billed charges,4.27,9.16,
NULYTELY 4 LITER,6400014,CDM,250,RC,,,Outpatient,,,95.5,76.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.4,80,,61.12,percent of total billed charges,80% of total billed charges,35.59,37.27,,28.47,percent of total billed charges,37.27% of total billed charges,35.59,37.27,,28.47,percent of total billed charges,37.27% of total billed charges,35.59,37.27,,28.47,percent of total billed charges,37.27% 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,38.2,40,,30.56,percent of total billed charges,40% of total billed charges,35.59,76.4,
NITRO-DUR 0.3MG/HR,6400014,CDM,250,RC,,,Outpatient,,,20.25,16.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,80,,12.96,percent of total billed charges,80% of total billed charges,7.55,37.27,,6.04,percent of total billed charges,37.27% of total billed charges,7.55,37.27,,6.04,percent of total billed charges,37.27% of total billed charges,7.55,37.27,,6.04,percent of total billed charges,37.27% 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,8.1,40,,6.48,percent of total billed charges,40% of total billed charges,7.55,16.2,
MECLIZINE 12.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.85,2.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,80,,1.82,percent of total billed charges,80% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% 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,1.14,40,,0.91,percent of total billed charges,40% of total billed charges,1.06,2.28,
MECLIZINE 25MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,2.85,2.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,80,,1.82,percent of total billed charges,80% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% 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,1.14,40,,0.91,percent of total billed charges,40% of total billed charges,1.06,2.28,
BETAPACE 80MG TAB,6400014,CDM,250,RC,,,Outpatient,,,8.7,6.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.96,80,,5.57,percent of total billed charges,80% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% 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,3.48,40,,2.78,percent of total billed charges,40% of total billed charges,3.24,6.96,
DIAZEPAM 5MG/ML INJ,6065130,CDM,636,RC,J3360,HCPCS,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
TRAVATAN 0.004% EYE,6400014,CDM,250,RC,,,Outpatient,,,336.45,269.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,269.16,80,,215.33,percent of total billed charges,80% of total billed charges,125.39,37.27,,100.31,percent of total billed charges,37.27% of total billed charges,125.39,37.27,,100.31,percent of total billed charges,37.27% of total billed charges,125.39,37.27,,100.31,percent of total billed charges,37.27% 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,134.58,40,,107.66,percent of total billed charges,40% of total billed charges,125.39,269.16,
NOVANTRONE PER 5 MG,6065130,CDM,636,RC,J9293,HCPCS,Outpatient,,,756.53,605.22,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,605.22,80,,484.18,percent of total billed charges,80% of total billed charges,281.96,37.27,,225.57,percent of total billed charges,37.27% of total billed charges,281.96,37.27,,225.57,percent of total billed charges,37.27% of total billed charges,281.96,37.27,,225.57,percent of total billed charges,37.27% of total billed charges,54.65,100,,,fee schedule,100% of APC rate,54.65,100,,,fee schedule,100% of APC rate,54.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,54.65,100,,,fee schedule,100% of APC rate,54.65,100,,,fee schedule,100% of APC rate,54.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,302.61,40,,242.09,percent of total billed charges,40% of total billed charges,54.65,605.22,
ACETAZOLAMIDE 125MG,6400014,CDM,250,RC,,,Outpatient,,,7.4,5.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.92,80,,4.74,percent of total billed charges,80% of total billed charges,2.76,37.27,,2.21,percent of total billed charges,37.27% of total billed charges,2.76,37.27,,2.21,percent of total billed charges,37.27% of total billed charges,2.76,37.27,,2.21,percent of total billed charges,37.27% 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,2.96,40,,2.37,percent of total billed charges,40% of total billed charges,2.76,5.92,
SYNTHROID 0.125 MG T,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
URISPAS TAB,6400014,CDM,250,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
BEXTRA 10MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,10.21,8.17,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.17,80,,6.54,percent of total billed charges,80% of total billed charges,3.81,37.27,,3.05,percent of total billed charges,37.27% of total billed charges,3.81,37.27,,3.05,percent of total billed charges,37.27% of total billed charges,3.81,37.27,,3.05,percent of total billed charges,37.27% 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,4.08,40,,3.26,percent of total billed charges,40% of total billed charges,3.81,8.17,
CELEBREX 200MG CAPSU,6400014,CDM,250,RC,,,Outpatient,,,49.3,39.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.44,80,,31.55,percent of total billed charges,80% of total billed charges,18.37,37.27,,14.7,percent of total billed charges,37.27% of total billed charges,18.37,37.27,,14.7,percent of total billed charges,37.27% of total billed charges,18.37,37.27,,14.7,percent of total billed charges,37.27% 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,19.72,40,,15.78,percent of total billed charges,40% of total billed charges,18.37,39.44,
TYLENOL EXTENDED REL,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
HYDROXYZINE HCL 10MG,6400014,CDM,250,RC,,,Outpatient,,,2.2,1.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,80,,1.41,percent of total billed charges,80% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% 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,0.88,40,,0.7,percent of total billed charges,40% of total billed charges,0.82,1.76,
HYDROXYZINE HCL 25MG,6400014,CDM,250,RC,,,Outpatient,,,3.1,2.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.48,80,,1.98,percent of total billed charges,80% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% 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,1.24,40,,0.99,percent of total billed charges,40% of total billed charges,1.16,2.48,
ATIVAN 1 MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,3.45,2.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.76,80,,2.21,percent of total billed charges,80% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% 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,1.38,40,,1.1,percent of total billed charges,40% of total billed charges,1.29,2.76,
CLARINEX 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,20.55,16.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.44,80,,13.15,percent of total billed charges,80% of total billed charges,7.66,37.27,,6.13,percent of total billed charges,37.27% of total billed charges,7.66,37.27,,6.13,percent of total billed charges,37.27% of total billed charges,7.66,37.27,,6.13,percent of total billed charges,37.27% 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,8.22,40,,6.58,percent of total billed charges,40% of total billed charges,7.66,16.44,
AZACTAM 1GM INJ,6065130,CDM,636,RC,J0457,HCPCS,Outpatient,,,140.15,112.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.12,80,,89.7,percent of total billed charges,80% of total billed charges,52.23,37.27,,41.78,percent of total billed charges,37.27% of total billed charges,52.23,37.27,,41.78,percent of total billed charges,37.27% of total billed charges,52.23,37.27,,41.78,percent of total billed charges,37.27% of total billed charges,1.97,100,,,fee schedule,100% of APC rate,1.97,100,,,fee schedule,100% of APC rate,1.97,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1.97,100,,,fee schedule,100% of APC rate,1.97,100,,,fee schedule,100% of APC rate,1.97,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.06,40,,44.85,percent of total billed charges,40% of total billed charges,1.97,112.12,
TEQUIN 200MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,28.42,22.74,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.74,80,,18.19,percent of total billed charges,80% of total billed charges,10.59,37.27,,8.47,percent of total billed charges,37.27% of total billed charges,10.59,37.27,,8.47,percent of total billed charges,37.27% of total billed charges,10.59,37.27,,8.47,percent of total billed charges,37.27% 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,11.37,40,,9.1,percent of total billed charges,40% of total billed charges,10.59,22.74,
NITROSTAT 0.3MG TABL,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
COLESTID TABLET 1 GM,6400014,CDM,250,RC,,,Outpatient,,,4.2,3.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.36,80,,2.69,percent of total billed charges,80% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% 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,1.68,40,,1.34,percent of total billed charges,40% of total billed charges,1.57,3.36,
BACTROBAN 2%,6400014,CDM,250,RC,,,Outpatient,,,48.3,38.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.64,80,,30.91,percent of total billed charges,80% of total billed charges,18,37.27,,14.4,percent of total billed charges,37.27% of total billed charges,18,37.27,,14.4,percent of total billed charges,37.27% of total billed charges,18,37.27,,14.4,percent of total billed charges,37.27% 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,19.32,40,,15.46,percent of total billed charges,40% of total billed charges,18,38.64,
DICYCLOMINE 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
BIAXIN-500MG TAB,6400014,CDM,250,RC,,,Outpatient,,,23.5,18.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.8,80,,15.04,percent of total billed charges,80% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% 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,9.4,40,,7.52,percent of total billed charges,40% of total billed charges,8.76,18.8,
KYTRIL INJ 1MG 1ML,6065130,CDM,636,RC,J1626,HCPCS,Outpatient,,,547.8,438.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,438.24,80,,350.59,percent of total billed charges,80% of total billed charges,204.17,37.27,,163.34,percent of total billed charges,37.27% of total billed charges,204.17,37.27,,163.34,percent of total billed charges,37.27% of total billed charges,204.17,37.27,,163.34,percent of total billed charges,37.27% 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,219.12,40,,175.3,percent of total billed charges,40% of total billed charges,204.17,438.24,
ACTOS 15MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,26.55,21.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.24,80,,16.99,percent of total billed charges,80% of total billed charges,9.9,37.27,,7.92,percent of total billed charges,37.27% of total billed charges,9.9,37.27,,7.92,percent of total billed charges,37.27% of total billed charges,9.9,37.27,,7.92,percent of total billed charges,37.27% 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,10.62,40,,8.5,percent of total billed charges,40% of total billed charges,9.9,21.24,
BETAGAN C CAP .5%,6400014,CDM,250,RC,,,Outpatient,,,55.45,44.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.36,80,,35.49,percent of total billed charges,80% of total billed charges,20.67,37.27,,16.54,percent of total billed charges,37.27% of total billed charges,20.67,37.27,,16.54,percent of total billed charges,37.27% of total billed charges,20.67,37.27,,16.54,percent of total billed charges,37.27% 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,22.18,40,,17.74,percent of total billed charges,40% of total billed charges,20.67,44.36,
VITAMIN C 250MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ZOSYN 3.375 GM PREMI,6065130,CDM,636,RC,J2543,HCPCS,Outpatient,,,109.3,87.44,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.44,80,,69.95,percent of total billed charges,80% of total billed charges,40.74,37.27,,32.59,percent of total billed charges,37.27% of total billed charges,40.74,37.27,,32.59,percent of total billed charges,37.27% of total billed charges,40.74,37.27,,32.59,percent of total billed charges,37.27% 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,43.72,40,,34.98,percent of total billed charges,40% of total billed charges,40.74,87.44,
MERREM 100MG,6065130,CDM,636,RC,J2185,HCPCS,Outpatient,,,27.46,21.97,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.97,80,,17.58,percent of total billed charges,80% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% 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,10.98,40,,8.78,percent of total billed charges,40% of total billed charges,10.23,21.97,
VITAMIN E 1000 UNITS,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
LIDODERM 5% PATCH (5,6400014,CDM,250,RC,,,Outpatient,,,90,72.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% 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,36,40,,28.8,percent of total billed charges,40% of total billed charges,33.54,72,
VIVARIN 200MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CAPOTEN 25MG TAB U/D,6400014,CDM,250,RC,,,Outpatient,,,2.5,2.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
MAXIPIME 2GM VIAL,6065130,CDM,636,RC,J0692,HCPCS,Outpatient,,,37.74,30.19,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.19,80,,24.15,percent of total billed charges,80% of total billed charges,14.07,37.27,,11.26,percent of total billed charges,37.27% of total billed charges,14.07,37.27,,11.26,percent of total billed charges,37.27% of total billed charges,14.07,37.27,,11.26,percent of total billed charges,37.27% 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,15.1,40,,12.08,percent of total billed charges,40% of total billed charges,14.07,30.19,
EMLA CREAM 5GM,6400014,CDM,250,RC,,,Outpatient,,,23.85,19.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.08,80,,15.26,percent of total billed charges,80% of total billed charges,8.89,37.27,,7.11,percent of total billed charges,37.27% of total billed charges,8.89,37.27,,7.11,percent of total billed charges,37.27% of total billed charges,8.89,37.27,,7.11,percent of total billed charges,37.27% 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,9.54,40,,7.63,percent of total billed charges,40% of total billed charges,8.89,19.08,
LESCOL 20MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,20.8,16.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,80,,13.31,percent of total billed charges,80% of total billed charges,7.75,37.27,,6.2,percent of total billed charges,37.27% of total billed charges,7.75,37.27,,6.2,percent of total billed charges,37.27% of total billed charges,7.75,37.27,,6.2,percent of total billed charges,37.27% 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,8.32,40,,6.66,percent of total billed charges,40% of total billed charges,7.75,16.64,
CLONIDINE 0.1MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.7,1.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.36,80,,1.09,percent of total billed charges,80% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% 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,0.68,40,,0.54,percent of total billed charges,40% of total billed charges,0.63,1.36,
CLONIDINE 0.2MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.7,2.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,80,,1.73,percent of total billed charges,80% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% 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,1.08,40,,0.86,percent of total billed charges,40% of total billed charges,1.01,2.16,
ALTACE 10MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,9.05,7.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.24,80,,5.79,percent of total billed charges,80% of total billed charges,3.37,37.27,,2.7,percent of total billed charges,37.27% of total billed charges,3.37,37.27,,2.7,percent of total billed charges,37.27% of total billed charges,3.37,37.27,,2.7,percent of total billed charges,37.27% 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,3.62,40,,2.9,percent of total billed charges,40% of total billed charges,3.37,7.24,
EXELON 3MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,16.05,12.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.84,80,,10.27,percent of total billed charges,80% of total billed charges,5.98,37.27,,4.78,percent of total billed charges,37.27% of total billed charges,5.98,37.27,,4.78,percent of total billed charges,37.27% of total billed charges,5.98,37.27,,4.78,percent of total billed charges,37.27% 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,6.42,40,,5.14,percent of total billed charges,40% of total billed charges,5.98,12.84,
CENTRUM TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.7,1.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.36,80,,1.09,percent of total billed charges,80% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% 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,0.68,40,,0.54,percent of total billed charges,40% of total billed charges,0.63,1.36,
RONDEC-DM SYRUP,6400014,CDM,250,RC,,,Outpatient,,,21.83,17.46,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.46,80,,13.97,percent of total billed charges,80% of total billed charges,8.14,37.27,,6.51,percent of total billed charges,37.27% of total billed charges,8.14,37.27,,6.51,percent of total billed charges,37.27% of total billed charges,8.14,37.27,,6.51,percent of total billed charges,37.27% 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,8.73,40,,6.98,percent of total billed charges,40% of total billed charges,8.14,17.46,
AMARYL 4MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,5.8,4.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.64,80,,3.71,percent of total billed charges,80% of total billed charges,2.16,37.27,,1.73,percent of total billed charges,37.27% of total billed charges,2.16,37.27,,1.73,percent of total billed charges,37.27% of total billed charges,2.16,37.27,,1.73,percent of total billed charges,37.27% 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,2.32,40,,1.86,percent of total billed charges,40% of total billed charges,2.16,4.64,
PRAMOSONE CREAM 2.5%,6400014,CDM,250,RC,,,Outpatient,,,38.15,30.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.52,80,,24.42,percent of total billed charges,80% of total billed charges,14.22,37.27,,11.38,percent of total billed charges,37.27% of total billed charges,14.22,37.27,,11.38,percent of total billed charges,37.27% of total billed charges,14.22,37.27,,11.38,percent of total billed charges,37.27% 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,15.26,40,,12.21,percent of total billed charges,40% of total billed charges,14.22,30.52,
PAXIL 30MG TAB,6400014,CDM,250,RC,,,Outpatient,,,10.82,8.66,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.66,80,,6.93,percent of total billed charges,80% of total billed charges,4.03,37.27,,3.22,percent of total billed charges,37.27% of total billed charges,4.03,37.27,,3.22,percent of total billed charges,37.27% of total billed charges,4.03,37.27,,3.22,percent of total billed charges,37.27% 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,4.33,40,,3.46,percent of total billed charges,40% of total billed charges,4.03,8.66,
CARDEC DM DROPS,6400014,CDM,250,RC,,,Outpatient,,,150.9,120.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.72,80,,96.58,percent of total billed charges,80% of total billed charges,56.24,37.27,,44.99,percent of total billed charges,37.27% of total billed charges,56.24,37.27,,44.99,percent of total billed charges,37.27% of total billed charges,56.24,37.27,,44.99,percent of total billed charges,37.27% 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,60.36,40,,48.29,percent of total billed charges,40% of total billed charges,56.24,120.72,
CHROMAGEN,6400014,CDM,250,RC,,,Outpatient,,,3.6,2.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,80,,2.3,percent of total billed charges,80% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% 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,1.44,40,,1.15,percent of total billed charges,40% of total billed charges,1.34,2.88,
KLONOPIN TAB 1MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
CEFZIL 500MG TAB,6400014,CDM,250,RC,,,Outpatient,,,15.55,12.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.44,80,,9.95,percent of total billed charges,80% of total billed charges,5.8,37.27,,4.64,percent of total billed charges,37.27% of total billed charges,5.8,37.27,,4.64,percent of total billed charges,37.27% of total billed charges,5.8,37.27,,4.64,percent of total billed charges,37.27% 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,6.22,40,,4.98,percent of total billed charges,40% of total billed charges,5.8,12.44,
BENZTROPINE 1MG,6400014,CDM,250,RC,,,Outpatient,,,1.95,1.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.56,80,,1.25,percent of total billed charges,80% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% 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,0.78,40,,0.62,percent of total billed charges,40% of total billed charges,0.73,1.56,
DOCUSATE SOD 50MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
COLCHICINE 0.6MG TAB,6400014,CDM,250,RC,,,Outpatient,,,29.4,23.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.52,80,,18.82,percent of total billed charges,80% of total billed charges,10.96,37.27,,8.77,percent of total billed charges,37.27% of total billed charges,10.96,37.27,,8.77,percent of total billed charges,37.27% of total billed charges,10.96,37.27,,8.77,percent of total billed charges,37.27% 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,11.76,40,,9.41,percent of total billed charges,40% of total billed charges,10.96,23.52,
FUROSEMIDE ORAL SOLN,6400014,CDM,250,RC,,,Outpatient,,,17.7,14.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.16,80,,11.33,percent of total billed charges,80% of total billed charges,6.6,37.27,,5.28,percent of total billed charges,37.27% of total billed charges,6.6,37.27,,5.28,percent of total billed charges,37.27% of total billed charges,6.6,37.27,,5.28,percent of total billed charges,37.27% 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,7.08,40,,5.66,percent of total billed charges,40% of total billed charges,6.6,14.16,
CORGARD 20MG,6400014,CDM,250,RC,,,Outpatient,,,2.6,2.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.08,80,,1.66,percent of total billed charges,80% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% 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,1.04,40,,0.83,percent of total billed charges,40% of total billed charges,0.97,2.08,
CARDIZEM 25MG VIAL,6400014,CDM,250,RC,,,Outpatient,,,47.2,37.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,80,,30.21,percent of total billed charges,80% of total billed charges,17.59,37.27,,14.07,percent of total billed charges,37.27% of total billed charges,17.59,37.27,,14.07,percent of total billed charges,37.27% of total billed charges,17.59,37.27,,14.07,percent of total billed charges,37.27% 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,18.88,40,,15.1,percent of total billed charges,40% of total billed charges,17.59,37.76,
ZANTAC 25MG/ML INJ 6,6065130,CDM,636,RC,J2780,HCPCS,Outpatient,,,202.55,162.04,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.04,80,,129.63,percent of total billed charges,80% of total billed charges,75.49,37.27,,60.39,percent of total billed charges,37.27% of total billed charges,75.49,37.27,,60.39,percent of total billed charges,37.27% of total billed charges,75.49,37.27,,60.39,percent of total billed charges,37.27% 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,81.02,40,,64.82,percent of total billed charges,40% of total billed charges,75.49,162.04,
CORGARD 40MG,6400014,CDM,250,RC,,,Outpatient,,,3.1,2.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.48,80,,1.98,percent of total billed charges,80% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% 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,1.24,40,,0.99,percent of total billed charges,40% of total billed charges,1.16,2.48,
PROPOFOL 10MG/ML VIA,6065130,CDM,636,RC,J2704,HCPCS,Outpatient,,,43.8,35.04,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.04,80,,28.03,percent of total billed charges,80% of total billed charges,16.32,37.27,,13.06,percent of total billed charges,37.27% of total billed charges,16.32,37.27,,13.06,percent of total billed charges,37.27% of total billed charges,16.32,37.27,,13.06,percent of total billed charges,37.27% 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,17.52,40,,14.02,percent of total billed charges,40% of total billed charges,16.32,35.04,
PROPOFOL 10MG/ML VIA,6065130,CDM,636,RC,J2704,HCPCS,Outpatient,,,109.6,87.68,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.68,80,,70.14,percent of total billed charges,80% of total billed charges,40.85,37.27,,32.68,percent of total billed charges,37.27% of total billed charges,40.85,37.27,,32.68,percent of total billed charges,37.27% of total billed charges,40.85,37.27,,32.68,percent of total billed charges,37.27% 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,43.84,40,,35.07,percent of total billed charges,40% of total billed charges,40.85,87.68,
COUMADIN 10MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
COUMADIN TAB 2.0MG U,6400014,CDM,250,RC,,,Outpatient,,,8.8,7.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,80,,5.63,percent of total billed charges,80% of total billed charges,3.28,37.27,,2.62,percent of total billed charges,37.27% of total billed charges,3.28,37.27,,2.62,percent of total billed charges,37.27% of total billed charges,3.28,37.27,,2.62,percent of total billed charges,37.27% 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,3.52,40,,2.82,percent of total billed charges,40% of total billed charges,3.28,7.04,
CARDIZEM SR 120MG,6400014,CDM,250,RC,,,Outpatient,,,4.1,3.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.28,80,,2.62,percent of total billed charges,80% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% 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,1.64,40,,1.31,percent of total billed charges,40% of total billed charges,1.53,3.28,
COUMADIN TAB 5.0MG U,6400014,CDM,250,RC,,,Outpatient,,,9.45,7.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,80,,6.05,percent of total billed charges,80% of total billed charges,3.52,37.27,,2.82,percent of total billed charges,37.27% of total billed charges,3.52,37.27,,2.82,percent of total billed charges,37.27% of total billed charges,3.52,37.27,,2.82,percent of total billed charges,37.27% 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,3.78,40,,3.02,percent of total billed charges,40% of total billed charges,3.52,7.56,
COUMADIN TAB 7.5MG U,6400014,CDM,250,RC,,,Outpatient,,,4,3.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
PEDIAPRED 5 MG/5 ML,6400014,CDM,250,RC,,,Outpatient,,,21.1,16.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.88,80,,13.5,percent of total billed charges,80% of total billed charges,7.86,37.27,,6.29,percent of total billed charges,37.27% of total billed charges,7.86,37.27,,6.29,percent of total billed charges,37.27% of total billed charges,7.86,37.27,,6.29,percent of total billed charges,37.27% 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,8.44,40,,6.75,percent of total billed charges,40% of total billed charges,7.86,16.88,
BUPROPION 100MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.6,2.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,80,,2.3,percent of total billed charges,80% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% 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,1.44,40,,1.15,percent of total billed charges,40% of total billed charges,1.34,2.88,
BIAXIN XL 500MG TABL,6400014,CDM,250,RC,,,Outpatient,,,41.1,32.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.88,80,,26.3,percent of total billed charges,80% of total billed charges,15.32,37.27,,12.26,percent of total billed charges,37.27% of total billed charges,15.32,37.27,,12.26,percent of total billed charges,37.27% of total billed charges,15.32,37.27,,12.26,percent of total billed charges,37.27% 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,16.44,40,,13.15,percent of total billed charges,40% of total billed charges,15.32,32.88,
COMPAZINE 5MG/ML VIA,6065130,CDM,636,RC,J0780,HCPCS,Outpatient,,,13.55,10.84,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.84,80,,8.67,percent of total billed charges,80% of total billed charges,5.05,37.27,,4.04,percent of total billed charges,37.27% of total billed charges,5.05,37.27,,4.04,percent of total billed charges,37.27% of total billed charges,5.05,37.27,,4.04,percent of total billed charges,37.27% 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,5.42,40,,4.34,percent of total billed charges,40% of total billed charges,5.05,10.84,
ACTONEL 5MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,29.15,23.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.32,80,,18.66,percent of total billed charges,80% of total billed charges,10.86,37.27,,8.69,percent of total billed charges,37.27% of total billed charges,10.86,37.27,,8.69,percent of total billed charges,37.27% of total billed charges,10.86,37.27,,8.69,percent of total billed charges,37.27% 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,11.66,40,,9.33,percent of total billed charges,40% of total billed charges,10.86,23.32,
INVANZ 1000MG,6065130,CDM,636,RC,J1335,HCPCS,Outpatient,,,263.23,210.58,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.58,80,,168.46,percent of total billed charges,80% of total billed charges,98.11,37.27,,78.49,percent of total billed charges,37.27% of total billed charges,98.11,37.27,,78.49,percent of total billed charges,37.27% of total billed charges,98.11,37.27,,78.49,percent of total billed charges,37.27% 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,105.29,40,,84.23,percent of total billed charges,40% of total billed charges,98.11,210.58,
FLURAZEPAM 15MG CAPS,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
ALLEGRA 180MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,9.75,7.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,80,,6.24,percent of total billed charges,80% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% 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,3.9,40,,3.12,percent of total billed charges,40% of total billed charges,3.63,7.8,
AMPICILLIN/SULBACTAM,6400014,CDM,250,RC,,,Outpatient,,,51.55,41.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.24,80,,32.99,percent of total billed charges,80% of total billed charges,19.21,37.27,,15.37,percent of total billed charges,37.27% of total billed charges,19.21,37.27,,15.37,percent of total billed charges,37.27% of total billed charges,19.21,37.27,,15.37,percent of total billed charges,37.27% 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,20.62,40,,16.5,percent of total billed charges,40% of total billed charges,19.21,41.24,
CROFAB (1GM=1VIAL),6400014,CDM,250,RC,J0840,HCPCS,Outpatient,,,5609.7,4487.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4487.76,80,,3590.21,percent of total billed charges,80% of total billed charges,2090.74,37.27,,1672.59,percent of total billed charges,37.27% of total billed charges,2090.74,37.27,,1672.59,percent of total billed charges,37.27% of total billed charges,2090.74,37.27,,1672.59,percent of total billed charges,37.27% of total billed charges,1762.35,100,,,fee schedule,100% of APC rate,1762.35,100,,,fee schedule,100% of APC rate,1762.35,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1762.35,100,,,fee schedule,100% of APC rate,1762.35,100,,,fee schedule,100% of APC rate,1762.35,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2243.88,40,,1795.1,percent of total billed charges,40% of total billed charges,1762.35,4487.76,
AMPICILLIN/SULBACTAM,6400014,CDM,250,RC,,,Outpatient,,,35,28.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28,80,,22.4,percent of total billed charges,80% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% 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,14,40,,11.2,percent of total billed charges,40% of total billed charges,13.04,28,
K-PEN SUSPENSION,6400014,CDM,250,RC,,,Outpatient,,,1.35,1.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.08,80,,0.86,percent of total billed charges,80% of total billed charges,0.5,37.27,,0.4,percent of total billed charges,37.27% of total billed charges,0.5,37.27,,0.4,percent of total billed charges,37.27% of total billed charges,0.5,37.27,,0.4,percent of total billed charges,37.27% 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,0.54,40,,0.43,percent of total billed charges,40% of total billed charges,0.5,1.08,
BEXTRA 20 MG TAB,6400014,CDM,250,RC,,,Outpatient,,,11.7,9.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.36,80,,7.49,percent of total billed charges,80% of total billed charges,4.36,37.27,,3.49,percent of total billed charges,37.27% of total billed charges,4.36,37.27,,3.49,percent of total billed charges,37.27% of total billed charges,4.36,37.27,,3.49,percent of total billed charges,37.27% 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,4.68,40,,3.74,percent of total billed charges,40% of total billed charges,4.36,9.36,
ULTRACET 37.5/325 MG,6400014,CDM,250,RC,,,Outpatient,,,4.2,3.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.36,80,,2.69,percent of total billed charges,80% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% 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,1.68,40,,1.34,percent of total billed charges,40% of total billed charges,1.57,3.36,
CREON CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
AMIKACIN WOUND DRESS,6400014,CDM,250,RC,,,Outpatient,,,231,184.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% 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,92.4,40,,73.92,percent of total billed charges,40% of total billed charges,86.09,184.8,
TRAZODONE 50MG UD,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
EXELON 4.5MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,23.4,18.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.72,80,,14.98,percent of total billed charges,80% of total billed charges,8.72,37.27,,6.98,percent of total billed charges,37.27% of total billed charges,8.72,37.27,,6.98,percent of total billed charges,37.27% of total billed charges,8.72,37.27,,6.98,percent of total billed charges,37.27% 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,9.36,40,,7.49,percent of total billed charges,40% of total billed charges,8.72,18.72,
CITRACAL + D CAPLET,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
DIAMOX 500MG SEQUELS,6400014,CDM,250,RC,,,Outpatient,,,31.7,25.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.36,80,,20.29,percent of total billed charges,80% of total billed charges,11.81,37.27,,9.45,percent of total billed charges,37.27% of total billed charges,11.81,37.27,,9.45,percent of total billed charges,37.27% of total billed charges,11.81,37.27,,9.45,percent of total billed charges,37.27% 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,12.68,40,,10.14,percent of total billed charges,40% of total billed charges,11.81,25.36,
MIRALAX 17GM PKDTUD,6400014,CDM,250,RC,,,Outpatient,,,9.45,7.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,80,,6.05,percent of total billed charges,80% of total billed charges,3.52,37.27,,2.82,percent of total billed charges,37.27% of total billed charges,3.52,37.27,,2.82,percent of total billed charges,37.27% of total billed charges,3.52,37.27,,2.82,percent of total billed charges,37.27% 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,3.78,40,,3.02,percent of total billed charges,40% of total billed charges,3.52,7.56,
NATRECOR 1.5MG/5ML V,6065130,CDM,636,RC,J2325,HCPCS,Outpatient,,,2880.4,2304.32,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2304.32,80,,1843.46,percent of total billed charges,80% of total billed charges,1073.53,37.27,,858.82,percent of total billed charges,37.27% of total billed charges,1073.53,37.27,,858.82,percent of total billed charges,37.27% of total billed charges,1073.53,37.27,,858.82,percent of total billed charges,37.27% 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,1152.16,40,,921.73,percent of total billed charges,40% of total billed charges,1073.53,2304.32,
ZOMETA INJ PER 1MG,6065130,CDM,636,RC,J3489,HCPCS,Outpatient,,,636.51,509.21,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,509.21,80,,407.37,percent of total billed charges,80% of total billed charges,237.23,37.27,,189.78,percent of total billed charges,37.27% of total billed charges,237.23,37.27,,189.78,percent of total billed charges,37.27% of total billed charges,237.23,37.27,,189.78,percent of total billed charges,37.27% 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,254.6,40,,203.68,percent of total billed charges,40% of total billed charges,237.23,509.21,
DILANTIN 100MG CAP.,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
DILOR-G TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
LOVENOX 100MG PREFIL,6065130,CDM,636,RC,J1650,HCPCS,Outpatient,,,307.95,246.36,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.36,80,,197.09,percent of total billed charges,80% of total billed charges,114.77,37.27,,91.82,percent of total billed charges,37.27% of total billed charges,114.77,37.27,,91.82,percent of total billed charges,37.27% of total billed charges,114.77,37.27,,91.82,percent of total billed charges,37.27% 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,123.18,40,,98.54,percent of total billed charges,40% of total billed charges,114.77,246.36,
GINKO BILOBA 60MG CA,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
DILTIAZEM 125MG/25ML,6400014,CDM,250,RC,,,Outpatient,,,78.35,62.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.68,80,,50.14,percent of total billed charges,80% of total billed charges,29.2,37.27,,23.36,percent of total billed charges,37.27% of total billed charges,29.2,37.27,,23.36,percent of total billed charges,37.27% of total billed charges,29.2,37.27,,23.36,percent of total billed charges,37.27% 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,31.34,40,,25.07,percent of total billed charges,40% of total billed charges,29.2,62.68,
ADVAIR DISKUS 250/50,6400014,CDM,250,RC,,,Outpatient,,,475.2,380.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380.16,80,,304.13,percent of total billed charges,80% of total billed charges,177.11,37.27,,141.69,percent of total billed charges,37.27% of total billed charges,177.11,37.27,,141.69,percent of total billed charges,37.27% of total billed charges,177.11,37.27,,141.69,percent of total billed charges,37.27% 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,190.08,40,,152.06,percent of total billed charges,40% of total billed charges,177.11,380.16,
OXYIR 5MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,6.5,5.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.2,80,,4.16,percent of total billed charges,80% of total billed charges,2.42,37.27,,1.94,percent of total billed charges,37.27% of total billed charges,2.42,37.27,,1.94,percent of total billed charges,37.27% of total billed charges,2.42,37.27,,1.94,percent of total billed charges,37.27% 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,2.6,40,,2.08,percent of total billed charges,40% of total billed charges,2.42,5.2,
DIPRIVAN 20ML AMP,6065130,CDM,636,RC,J2704,HCPCS,Outpatient,,,105,84.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% 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,42,40,,33.6,percent of total billed charges,40% of total billed charges,39.13,84,
ACTOS 45MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,36.45,29.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.16,80,,23.33,percent of total billed charges,80% of total billed charges,13.58,37.27,,10.86,percent of total billed charges,37.27% of total billed charges,13.58,37.27,,10.86,percent of total billed charges,37.27% of total billed charges,13.58,37.27,,10.86,percent of total billed charges,37.27% 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,14.58,40,,11.66,percent of total billed charges,40% of total billed charges,13.58,29.16,
DONNATAL TAB UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
DIFLUCAN IV,6065130,CDM,636,RC,J1450,HCPCS,Outpatient,,,420.55,336.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336.44,80,,269.15,percent of total billed charges,80% of total billed charges,156.74,37.27,,125.39,percent of total billed charges,37.27% of total billed charges,156.74,37.27,,125.39,percent of total billed charges,37.27% of total billed charges,156.74,37.27,,125.39,percent of total billed charges,37.27% 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,168.22,40,,134.58,percent of total billed charges,40% of total billed charges,156.74,336.44,
CARDURA 1MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.25,2.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.6,80,,2.08,percent of total billed charges,80% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% 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,1.3,40,,1.04,percent of total billed charges,40% of total billed charges,1.21,2.6,
SELENIUM 50MCG TABLE,6400014,CDM,250,RC,,,Outpatient,,,1.7,1.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.36,80,,1.09,percent of total billed charges,80% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% 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,0.68,40,,0.54,percent of total billed charges,40% of total billed charges,0.63,1.36,
DOXIDAN CAP,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
MACARDIS HCT 80/12.5,6400014,CDM,250,RC,,,Outpatient,,,27.25,21.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.8,80,,17.44,percent of total billed charges,80% of total billed charges,10.16,37.27,,8.13,percent of total billed charges,37.27% of total billed charges,10.16,37.27,,8.13,percent of total billed charges,37.27% of total billed charges,10.16,37.27,,8.13,percent of total billed charges,37.27% 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,10.9,40,,8.72,percent of total billed charges,40% of total billed charges,10.16,21.8,
FOLTX TABLET,6400014,CDM,250,RC,,,Outpatient,,,3.45,2.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.76,80,,2.21,percent of total billed charges,80% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% 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,1.38,40,,1.1,percent of total billed charges,40% of total billed charges,1.29,2.76,
PAXIL CR 25 MG TAB,6400014,CDM,250,RC,,,Outpatient,,,17.95,14.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.36,80,,11.49,percent of total billed charges,80% of total billed charges,6.69,37.27,,5.35,percent of total billed charges,37.27% of total billed charges,6.69,37.27,,5.35,percent of total billed charges,37.27% of total billed charges,6.69,37.27,,5.35,percent of total billed charges,37.27% 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,7.18,40,,5.74,percent of total billed charges,40% of total billed charges,6.69,14.36,
PAXIL CR 12.5 MG TAB,6400014,CDM,250,RC,,,Outpatient,,,19.15,15.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.32,80,,12.26,percent of total billed charges,80% of total billed charges,7.14,37.27,,5.71,percent of total billed charges,37.27% of total billed charges,7.14,37.27,,5.71,percent of total billed charges,37.27% of total billed charges,7.14,37.27,,5.71,percent of total billed charges,37.27% 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,7.66,40,,6.13,percent of total billed charges,40% of total billed charges,7.14,15.32,
TRIAMTERENE AND HCTZ,6400014,CDM,250,RC,,,Outpatient,,,1.95,1.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.56,80,,1.25,percent of total billed charges,80% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% 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,0.78,40,,0.62,percent of total billed charges,40% of total billed charges,0.73,1.56,
CEFTIN 125MG/5ML 100,5880901,CDM,637,RC,,,Outpatient,,,540.25,432.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,432.2,80,,345.76,percent of total billed charges,80% of total billed charges,201.35,37.27,,161.08,percent of total billed charges,37.27% of total billed charges,201.35,37.27,,161.08,percent of total billed charges,37.27% of total billed charges,201.35,37.27,,161.08,percent of total billed charges,37.27% 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,216.1,40,,172.88,percent of total billed charges,40% of total billed charges,201.35,432.2,
VITAMIN E CAPS 200 U,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
VITAMIN E CAPS 400 U,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ASPIRIN-ENTERIC COAT,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
POLY-VENT CAPLET SA,6400014,CDM,250,RC,,,Outpatient,,,3.35,2.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.68,80,,2.14,percent of total billed charges,80% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% 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,1.34,40,,1.07,percent of total billed charges,40% of total billed charges,1.25,2.68,
AMITRIPTYLINE 50MG T,6400014,CDM,250,RC,,,Outpatient,,,2.2,1.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,80,,1.41,percent of total billed charges,80% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% 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,0.88,40,,0.7,percent of total billed charges,40% of total billed charges,0.82,1.76,
HUMULIN 70/30 1ML,6400014,CDM,250,RC,,,Outpatient,,,16.46,13.17,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.17,80,,10.54,percent of total billed charges,80% of total billed charges,6.13,37.27,,4.9,percent of total billed charges,37.27% of total billed charges,6.13,37.27,,4.9,percent of total billed charges,37.27% of total billed charges,6.13,37.27,,4.9,percent of total billed charges,37.27% 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,6.58,40,,5.26,percent of total billed charges,40% of total billed charges,6.13,13.17,
ENDURONYL TAB,6400014,CDM,250,RC,,,Outpatient,,,6.45,5.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.16,80,,4.13,percent of total billed charges,80% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% 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,2.58,40,,2.06,percent of total billed charges,40% of total billed charges,2.4,5.16,
ULTIVA 2MG VIAL,6400014,CDM,250,RC,,,Outpatient,,,84.45,67.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.56,80,,54.05,percent of total billed charges,80% of total billed charges,31.47,37.27,,25.18,percent of total billed charges,37.27% of total billed charges,31.47,37.27,,25.18,percent of total billed charges,37.27% of total billed charges,31.47,37.27,,25.18,percent of total billed charges,37.27% 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,33.78,40,,27.02,percent of total billed charges,40% of total billed charges,31.47,67.56,
HYDRO-TUSSIN XP SYRU,6400014,CDM,250,RC,,,Outpatient,,,9.8,7.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.84,80,,6.27,percent of total billed charges,80% of total billed charges,3.65,37.27,,2.92,percent of total billed charges,37.27% of total billed charges,3.65,37.27,,2.92,percent of total billed charges,37.27% of total billed charges,3.65,37.27,,2.92,percent of total billed charges,37.27% 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,3.92,40,,3.14,percent of total billed charges,40% of total billed charges,3.65,7.84,
HYDRO-TUSSIN HC SYRU,6400014,CDM,250,RC,,,Outpatient,,,9.56,7.65,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.65,80,,6.12,percent of total billed charges,80% of total billed charges,3.56,37.27,,2.85,percent of total billed charges,37.27% of total billed charges,3.56,37.27,,2.85,percent of total billed charges,37.27% of total billed charges,3.56,37.27,,2.85,percent of total billed charges,37.27% 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,3.82,40,,3.06,percent of total billed charges,40% of total billed charges,3.56,7.65,
COMTAN 200MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,31.55,25.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.24,80,,20.19,percent of total billed charges,80% of total billed charges,11.76,37.27,,9.41,percent of total billed charges,37.27% of total billed charges,11.76,37.27,,9.41,percent of total billed charges,37.27% of total billed charges,11.76,37.27,,9.41,percent of total billed charges,37.27% 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,12.62,40,,10.1,percent of total billed charges,40% of total billed charges,11.76,25.24,
ACTIGALL CAP 300MG,6400014,CDM,250,RC,,,Outpatient,,,27.85,22.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.28,80,,17.82,percent of total billed charges,80% of total billed charges,10.38,37.27,,8.3,percent of total billed charges,37.27% of total billed charges,10.38,37.27,,8.3,percent of total billed charges,37.27% of total billed charges,10.38,37.27,,8.3,percent of total billed charges,37.27% 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,11.14,40,,8.91,percent of total billed charges,40% of total billed charges,10.38,22.28,
CHIROCAINE 0.5% 30ML,6400014,CDM,250,RC,,,Outpatient,,,35.44,28.35,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.35,80,,22.68,percent of total billed charges,80% of total billed charges,13.21,37.27,,10.57,percent of total billed charges,37.27% of total billed charges,13.21,37.27,,10.57,percent of total billed charges,37.27% of total billed charges,13.21,37.27,,10.57,percent of total billed charges,37.27% 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,14.18,40,,11.34,percent of total billed charges,40% of total billed charges,13.21,28.35,
DEPAKOTE 500MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,6.35,5.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.08,80,,4.06,percent of total billed charges,80% of total billed charges,2.37,37.27,,1.9,percent of total billed charges,37.27% of total billed charges,2.37,37.27,,1.9,percent of total billed charges,37.27% of total billed charges,2.37,37.27,,1.9,percent of total billed charges,37.27% 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,2.54,40,,2.03,percent of total billed charges,40% of total billed charges,2.37,5.08,
COUMADIN TAB 10MG UD,6400014,CDM,250,RC,,,Outpatient,,,4.2,3.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.36,80,,2.69,percent of total billed charges,80% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% 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,1.68,40,,1.34,percent of total billed charges,40% of total billed charges,1.57,3.36,
CANCIDAS IV PER 5 MG,6065130,CDM,636,RC,J0637,HCPCS,Outpatient,,,139.31,111.45,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.45,80,,89.16,percent of total billed charges,80% of total billed charges,51.92,37.27,,41.54,percent of total billed charges,37.27% of total billed charges,51.92,37.27,,41.54,percent of total billed charges,37.27% of total billed charges,51.92,37.27,,41.54,percent of total billed charges,37.27% 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,55.72,40,,44.58,percent of total billed charges,40% of total billed charges,51.92,111.45,
AVEENO DAILY MOIST L,6400014,CDM,250,RC,,,Outpatient,,,22.11,17.69,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.69,80,,14.15,percent of total billed charges,80% of total billed charges,8.24,37.27,,6.59,percent of total billed charges,37.27% of total billed charges,8.24,37.27,,6.59,percent of total billed charges,37.27% of total billed charges,8.24,37.27,,6.59,percent of total billed charges,37.27% 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,8.84,40,,7.07,percent of total billed charges,40% of total billed charges,8.24,17.69,
HEPATITIS B IMMUNE G,6065130,CDM,636,RC,J1571,HCPCS,Outpatient,,,361.95,289.56,JG,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.56,80,,231.65,percent of total billed charges,80% of total billed charges,134.9,37.27,,107.92,percent of total billed charges,37.27% of total billed charges,134.9,37.27,,107.92,percent of total billed charges,37.27% of total billed charges,134.9,37.27,,107.92,percent of total billed charges,37.27% of total billed charges,68.66,100,,,fee schedule,100% of APC rate,68.66,100,,,fee schedule,100% of APC rate,68.66,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,68.66,100,,,fee schedule,100% of APC rate,68.66,100,,,fee schedule,100% of APC rate,68.66,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.78,40,,115.82,percent of total billed charges,40% of total billed charges,68.66,289.56,
MYSOLINE TAB 50MG,6400014,CDM,250,RC,,,Outpatient,,,1.7,1.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.36,80,,1.09,percent of total billed charges,80% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% 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,0.68,40,,0.54,percent of total billed charges,40% of total billed charges,0.63,1.36,
LIPITOR 40MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,19.65,15.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.72,80,,12.58,percent of total billed charges,80% of total billed charges,7.32,37.27,,5.86,percent of total billed charges,37.27% of total billed charges,7.32,37.27,,5.86,percent of total billed charges,37.27% of total billed charges,7.32,37.27,,5.86,percent of total billed charges,37.27% 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,7.86,40,,6.29,percent of total billed charges,40% of total billed charges,7.32,15.72,
EPINEPHRINE ABBOJECT,6065130,CDM,636,RC,J0171,HCPCS,Outpatient,,,40.45,32.36,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.36,80,,25.89,percent of total billed charges,80% of total billed charges,15.08,37.27,,12.06,percent of total billed charges,37.27% of total billed charges,15.08,37.27,,12.06,percent of total billed charges,37.27% of total billed charges,15.08,37.27,,12.06,percent of total billed charges,37.27% 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,16.18,40,,12.94,percent of total billed charges,40% of total billed charges,15.08,32.36,
FLUOR-I-STRIP-A.T.,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
FERROSEQUELS,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
FERROUS SULF,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ROBINUL FORTE 2MG TA,6400014,CDM,250,RC,,,Outpatient,,,36.85,29.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.48,80,,23.58,percent of total billed charges,80% of total billed charges,13.73,37.27,,10.98,percent of total billed charges,37.27% of total billed charges,13.73,37.27,,10.98,percent of total billed charges,37.27% of total billed charges,13.73,37.27,,10.98,percent of total billed charges,37.27% 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,14.74,40,,11.79,percent of total billed charges,40% of total billed charges,13.73,29.48,
AMERGE 2.5 MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,107.65,86.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.12,80,,68.9,percent of total billed charges,80% of total billed charges,40.12,37.27,,32.1,percent of total billed charges,37.27% of total billed charges,40.12,37.27,,32.1,percent of total billed charges,37.27% of total billed charges,40.12,37.27,,32.1,percent of total billed charges,37.27% 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,43.06,40,,34.45,percent of total billed charges,40% of total billed charges,40.12,86.12,
FIORINAL CAP NO 3 U/,6400014,CDM,250,RC,,,Outpatient,,,10.65,8.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.52,80,,6.82,percent of total billed charges,80% of total billed charges,3.97,37.27,,3.18,percent of total billed charges,37.27% of total billed charges,3.97,37.27,,3.18,percent of total billed charges,37.27% of total billed charges,3.97,37.27,,3.18,percent of total billed charges,37.27% 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,4.26,40,,3.41,percent of total billed charges,40% of total billed charges,3.97,8.52,
FIORINAL TABLET U/D,6400014,CDM,250,RC,,,Outpatient,,,18.8,15.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,80,,12.03,percent of total billed charges,80% of total billed charges,7.01,37.27,,5.61,percent of total billed charges,37.27% of total billed charges,7.01,37.27,,5.61,percent of total billed charges,37.27% of total billed charges,7.01,37.27,,5.61,percent of total billed charges,37.27% 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,7.52,40,,6.02,percent of total billed charges,40% of total billed charges,7.01,15.04,
CONCERTA ER 18MG TAB,6400014,CDM,250,RC,,,Outpatient,,,9.8,7.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.84,80,,6.27,percent of total billed charges,80% of total billed charges,3.65,37.27,,2.92,percent of total billed charges,37.27% of total billed charges,3.65,37.27,,2.92,percent of total billed charges,37.27% of total billed charges,3.65,37.27,,2.92,percent of total billed charges,37.27% 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,3.92,40,,3.14,percent of total billed charges,40% of total billed charges,3.65,7.84,
FOLIC ACID 1MG U/D,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ACTONEL 35MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,296.65,237.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,237.32,80,,189.86,percent of total billed charges,80% of total billed charges,110.56,37.27,,88.45,percent of total billed charges,37.27% of total billed charges,110.56,37.27,,88.45,percent of total billed charges,37.27% of total billed charges,110.56,37.27,,88.45,percent of total billed charges,37.27% 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,118.66,40,,94.93,percent of total billed charges,40% of total billed charges,110.56,237.32,
ACCUPRIL 40MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,6.05,4.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,80,,3.87,percent of total billed charges,80% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% 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,2.42,40,,1.94,percent of total billed charges,40% of total billed charges,2.25,4.84,
DEXAMETHASONE 1MG/ML,6400014,CDM,250,RC,,,Outpatient,,,18.25,14.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.6,80,,11.68,percent of total billed charges,80% of total billed charges,6.8,37.27,,5.44,percent of total billed charges,37.27% of total billed charges,6.8,37.27,,5.44,percent of total billed charges,37.27% of total billed charges,6.8,37.27,,5.44,percent of total billed charges,37.27% 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,7.3,40,,5.84,percent of total billed charges,40% of total billed charges,6.8,14.6,
SANDOSTATIN LAR 20MG,6065130,CDM,636,RC,J2353,HCPCS,Outpatient,,,7377.65,5902.12,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5902.12,80,,4721.7,percent of total billed charges,80% of total billed charges,2749.65,37.27,,2199.72,percent of total billed charges,37.27% of total billed charges,2749.65,37.27,,2199.72,percent of total billed charges,37.27% of total billed charges,2749.65,37.27,,2199.72,percent of total billed charges,37.27% of total billed charges,214.88,100,,,fee schedule,100% of APC rate,214.88,100,,,fee schedule,100% of APC rate,214.88,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,214.88,100,,,fee schedule,100% of APC rate,214.88,100,,,fee schedule,100% of APC rate,214.88,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2951.06,40,,2360.85,percent of total billed charges,40% of total billed charges,214.88,5902.12,
SINGULAIR 4MG TAB CH,6400014,CDM,250,RC,,,Outpatient,,,21.4,17.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.12,80,,13.7,percent of total billed charges,80% of total billed charges,7.98,37.27,,6.38,percent of total billed charges,37.27% of total billed charges,7.98,37.27,,6.38,percent of total billed charges,37.27% of total billed charges,7.98,37.27,,6.38,percent of total billed charges,37.27% 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,8.56,40,,6.85,percent of total billed charges,40% of total billed charges,7.98,17.12,
GAVISCON FOAM TABS,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
HALDOL 1MG TABLET UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
HALDOL 5MG TABLET UD,6400014,CDM,250,RC,,,Outpatient,,,4.2,3.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.36,80,,2.69,percent of total billed charges,80% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% 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,1.68,40,,1.34,percent of total billed charges,40% of total billed charges,1.57,3.36,
ASPIRIN BABY 81MG TA,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
GLUCOVANCE 2.5/500MG,6400014,CDM,250,RC,,,Outpatient,,,5.3,4.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.24,80,,3.39,percent of total billed charges,80% of total billed charges,1.98,37.27,,1.58,percent of total billed charges,37.27% of total billed charges,1.98,37.27,,1.58,percent of total billed charges,37.27% of total billed charges,1.98,37.27,,1.58,percent of total billed charges,37.27% 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,2.12,40,,1.7,percent of total billed charges,40% of total billed charges,1.98,4.24,
TOPAMAX 100MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,73.05,58.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.44,80,,46.75,percent of total billed charges,80% of total billed charges,27.23,37.27,,21.78,percent of total billed charges,37.27% of total billed charges,27.23,37.27,,21.78,percent of total billed charges,37.27% of total billed charges,27.23,37.27,,21.78,percent of total billed charges,37.27% 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,29.22,40,,23.38,percent of total billed charges,40% of total billed charges,27.23,58.44,
IMODIUM 2MG CAP. U/D,6400014,CDM,250,RC,,,Outpatient,,,2.4,1.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,80,,1.54,percent of total billed charges,80% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% 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,0.96,40,,0.77,percent of total billed charges,40% of total billed charges,0.89,1.92,
INDERAL 20MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
PROPRANOLOL 40MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
K-LYTE 25MEQ,6400014,CDM,250,RC,,,Outpatient,,,2.4,1.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,80,,1.54,percent of total billed charges,80% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% 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,0.96,40,,0.77,percent of total billed charges,40% of total billed charges,0.89,1.92,
ESKALITH CR 450MG,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
ZENICAL 120MG CAPSUL,6400014,CDM,250,RC,,,Outpatient,,,4.35,3.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.48,80,,2.78,percent of total billed charges,80% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% 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,1.74,40,,1.39,percent of total billed charges,40% of total billed charges,1.62,3.48,
KERLONE 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.45,1.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.96,80,,1.57,percent of total billed charges,80% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% 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,0.98,40,,0.78,percent of total billed charges,40% of total billed charges,0.91,1.96,
BETADINE SOLN 16OZ,6400014,CDM,250,RC,,,Outpatient,,,34.25,27.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.4,80,,21.92,percent of total billed charges,80% of total billed charges,12.76,37.27,,10.21,percent of total billed charges,37.27% of total billed charges,12.76,37.27,,10.21,percent of total billed charges,37.27% of total billed charges,12.76,37.27,,10.21,percent of total billed charges,37.27% 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,13.7,40,,10.96,percent of total billed charges,40% of total billed charges,12.76,27.4,
LACTINEX GRANULE PAC,6400014,CDM,250,RC,,,Outpatient,,,6.9,5.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.52,80,,4.42,percent of total billed charges,80% of total billed charges,2.57,37.27,,2.06,percent of total billed charges,37.27% of total billed charges,2.57,37.27,,2.06,percent of total billed charges,37.27% of total billed charges,2.57,37.27,,2.06,percent of total billed charges,37.27% 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,2.76,40,,2.21,percent of total billed charges,40% of total billed charges,2.57,5.52,
LACTINEX TABS,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
LANOXICAPS 0.1MG CAP,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
LANOXIN 0.125MG TAB,6400014,CDM,250,RC,,,Outpatient,,,7.85,6.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.28,80,,5.02,percent of total billed charges,80% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% 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,3.14,40,,2.51,percent of total billed charges,40% of total billed charges,2.93,6.28,
LANOXIN 0.25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
LASIX 40MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
LEVSIN 0.125MG,6400014,CDM,250,RC,,,Outpatient,,,3.45,2.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.76,80,,2.21,percent of total billed charges,80% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% 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,1.38,40,,1.1,percent of total billed charges,40% of total billed charges,1.29,2.76,
LIBRIUM 25MG CAP,6400014,CDM,250,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
LIMBITROL,6400014,CDM,250,RC,,,Outpatient,,,6.15,4.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.92,80,,3.94,percent of total billed charges,80% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% 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,2.46,40,,1.97,percent of total billed charges,40% of total billed charges,2.29,4.92,
LOPRESSOR 50MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
LOPRESSOR 100MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.5,2.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
TRILEPTAL 300MG TABL,6400014,CDM,250,RC,,,Outpatient,,,12.35,9.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.88,80,,7.9,percent of total billed charges,80% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% 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,4.94,40,,3.95,percent of total billed charges,40% of total billed charges,4.6,9.88,
MACRODANTIN 50MG CAP,6400014,CDM,250,RC,,,Outpatient,,,15.05,12.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.04,80,,9.63,percent of total billed charges,80% of total billed charges,5.61,37.27,,4.49,percent of total billed charges,37.27% of total billed charges,5.61,37.27,,4.49,percent of total billed charges,37.27% of total billed charges,5.61,37.27,,4.49,percent of total billed charges,37.27% 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,6.02,40,,4.82,percent of total billed charges,40% of total billed charges,5.61,12.04,
OPTIPRANOLOL OPHT SO,6400014,CDM,250,RC,,,Outpatient,,,86.55,69.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.24,80,,55.39,percent of total billed charges,80% of total billed charges,32.26,37.27,,25.81,percent of total billed charges,37.27% of total billed charges,32.26,37.27,,25.81,percent of total billed charges,37.27% of total billed charges,32.26,37.27,,25.81,percent of total billed charges,37.27% 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,34.62,40,,27.7,percent of total billed charges,40% of total billed charges,32.26,69.24,
MEPHYTON 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,204.45,163.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.56,80,,130.85,percent of total billed charges,80% of total billed charges,76.2,37.27,,60.96,percent of total billed charges,37.27% of total billed charges,76.2,37.27,,60.96,percent of total billed charges,37.27% of total billed charges,76.2,37.27,,60.96,percent of total billed charges,37.27% 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,81.78,40,,65.42,percent of total billed charges,40% of total billed charges,76.2,163.56,
METAMUCIL PKT U/D,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
METHERGINE 0.2MG PO,6400014,CDM,250,RC,,,Outpatient,,,5.85,4.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.68,80,,3.74,percent of total billed charges,80% of total billed charges,2.18,37.27,,1.74,percent of total billed charges,37.27% of total billed charges,2.18,37.27,,1.74,percent of total billed charges,37.27% of total billed charges,2.18,37.27,,1.74,percent of total billed charges,37.27% 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,2.34,40,,1.87,percent of total billed charges,40% of total billed charges,2.18,4.68,
MICRO-K 8MEQ (600MG),6400014,CDM,250,RC,,,Outpatient,,,2.95,2.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,80,,1.89,percent of total billed charges,80% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% 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,1.18,40,,0.94,percent of total billed charges,40% of total billed charges,1.1,2.36,
CODEINE 15MG/5ML SOL,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
MINIPRESS 1MG,6400014,CDM,250,RC,,,Outpatient,,,6.15,4.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.92,80,,3.94,percent of total billed charges,80% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% 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,2.46,40,,1.97,percent of total billed charges,40% of total billed charges,2.29,4.92,
MINIPRESS 2MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
MINIPRESS 5MG,6400014,CDM,250,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
MINIZIDE 1MG CAP,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
MOTRIN 400MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
MYAMBUTOL 400MG,6400014,CDM,250,RC,,,Outpatient,,,6.05,4.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,80,,3.87,percent of total billed charges,80% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% 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,2.42,40,,1.94,percent of total billed charges,40% of total billed charges,2.25,4.84,
MYLICIB 80MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
PROZAC 10MG,6400014,CDM,250,RC,,,Outpatient,,,6.5,5.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.2,80,,4.16,percent of total billed charges,80% of total billed charges,2.42,37.27,,1.94,percent of total billed charges,37.27% of total billed charges,2.42,37.27,,1.94,percent of total billed charges,37.27% of total billed charges,2.42,37.27,,1.94,percent of total billed charges,37.27% 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,2.6,40,,2.08,percent of total billed charges,40% of total billed charges,2.42,5.2,
SYNTHROID 0.112 MG T,6400014,CDM,250,RC,,,Outpatient,,,6.45,5.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.16,80,,4.13,percent of total billed charges,80% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% 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,2.58,40,,2.06,percent of total billed charges,40% of total billed charges,2.4,5.16,
NAVANE 2MG CAP,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
NAVANE 5MG CAP,6400014,CDM,250,RC,,,Outpatient,,,2.4,1.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,80,,1.54,percent of total billed charges,80% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% 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,0.96,40,,0.77,percent of total billed charges,40% of total billed charges,0.89,1.92,
NIACIN 100MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
NEW SKIN,6400014,CDM,250,RC,,,Outpatient,,,15.25,12.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.2,80,,9.76,percent of total billed charges,80% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% 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,6.1,40,,4.88,percent of total billed charges,40% of total billed charges,5.68,12.2,
NITROGLYCERIN SR CAP,6400014,CDM,250,RC,,,Outpatient,,,3.05,2.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.44,80,,1.95,percent of total billed charges,80% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% 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,1.22,40,,0.98,percent of total billed charges,40% of total billed charges,1.14,2.44,
LEVATOL TAB 20MG,6400014,CDM,250,RC,,,Outpatient,,,13.85,11.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.08,80,,8.86,percent of total billed charges,80% of total billed charges,5.16,37.27,,4.13,percent of total billed charges,37.27% of total billed charges,5.16,37.27,,4.13,percent of total billed charges,37.27% of total billed charges,5.16,37.27,,4.13,percent of total billed charges,37.27% 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,5.54,40,,4.43,percent of total billed charges,40% of total billed charges,5.16,11.08,
NOLVADEX 10MG (TAMOX,6400014,CDM,250,RC,,,Outpatient,,,8.05,6.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.44,80,,5.15,percent of total billed charges,80% of total billed charges,3,37.27,,2.4,percent of total billed charges,37.27% of total billed charges,3,37.27,,2.4,percent of total billed charges,37.27% of total billed charges,3,37.27,,2.4,percent of total billed charges,37.27% 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,3.22,40,,2.58,percent of total billed charges,40% of total billed charges,3,6.44,
FOSAMAX-10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,5.91,4.73,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.73,80,,3.78,percent of total billed charges,80% of total billed charges,2.2,37.27,,1.76,percent of total billed charges,37.27% of total billed charges,2.2,37.27,,1.76,percent of total billed charges,37.27% of total billed charges,2.2,37.27,,1.76,percent of total billed charges,37.27% 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,2.36,40,,1.89,percent of total billed charges,40% of total billed charges,2.2,4.73,
ZITHROMAX SUSP 200MG,6400014,CDM,250,RC,,,Outpatient,,,109.66,87.73,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.73,80,,70.18,percent of total billed charges,80% of total billed charges,40.87,37.27,,32.7,percent of total billed charges,37.27% of total billed charges,40.87,37.27,,32.7,percent of total billed charges,37.27% of total billed charges,40.87,37.27,,32.7,percent of total billed charges,37.27% 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,43.86,40,,35.09,percent of total billed charges,40% of total billed charges,40.87,87.73,
BREVIBLOC 10MG/ML VI,6065130,CDM,636,RC,J1805,HCPCS,Outpatient,,,75.85,60.68,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.68,80,,48.54,percent of total billed charges,80% of total billed charges,28.27,37.27,,22.62,percent of total billed charges,37.27% of total billed charges,28.27,37.27,,22.62,percent of total billed charges,37.27% of total billed charges,28.27,37.27,,22.62,percent of total billed charges,37.27% of total billed charges,0.19,100,,,fee schedule,100% of APC rate,0.19,100,,,fee schedule,100% of APC rate,0.19,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.19,100,,,fee schedule,100% of APC rate,0.19,100,,,fee schedule,100% of APC rate,0.19,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.34,40,,24.27,percent of total billed charges,40% of total billed charges,0.19,60.68,
ZITHROMAX SUSP 200MG,6400014,CDM,250,RC,,,Outpatient,,,109.66,87.73,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.73,80,,70.18,percent of total billed charges,80% of total billed charges,40.87,37.27,,32.7,percent of total billed charges,37.27% of total billed charges,40.87,37.27,,32.7,percent of total billed charges,37.27% of total billed charges,40.87,37.27,,32.7,percent of total billed charges,37.27% 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,43.86,40,,35.09,percent of total billed charges,40% of total billed charges,40.87,87.73,
ZITHROMAX SUSP 100MG,6400014,CDM,250,RC,,,Outpatient,,,130.3,104.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.24,80,,83.39,percent of total billed charges,80% of total billed charges,48.56,37.27,,38.85,percent of total billed charges,37.27% of total billed charges,48.56,37.27,,38.85,percent of total billed charges,37.27% of total billed charges,48.56,37.27,,38.85,percent of total billed charges,37.27% 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,52.12,40,,41.7,percent of total billed charges,40% of total billed charges,48.56,104.24,
TORADOL 30MG/CC -1CC,6065130,CDM,636,RC,J1885,HCPCS,Outpatient,,,30.6,24.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.48,80,,19.58,percent of total billed charges,80% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% 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,12.24,40,,9.79,percent of total billed charges,40% of total billed charges,11.4,24.48,
OGEN 1.25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ORAGRAFIN CAPS (6),6000905,CDM,255,RC,,,Outpatient,,,19.15,15.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.32,80,,12.26,percent of total billed charges,80% of total billed charges,7.14,37.27,,5.71,percent of total billed charges,37.27% of total billed charges,7.14,37.27,,5.71,percent of total billed charges,37.27% of total billed charges,7.14,37.27,,5.71,percent of total billed charges,37.27% 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,7.66,40,,6.13,percent of total billed charges,40% of total billed charges,7.14,15.32,
LORTAB ELIXIR,6400014,CDM,250,RC,,,Outpatient,,,12.55,10.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.04,80,,8.03,percent of total billed charges,80% of total billed charges,4.68,37.27,,3.74,percent of total billed charges,37.27% of total billed charges,4.68,37.27,,3.74,percent of total billed charges,37.27% of total billed charges,4.68,37.27,,3.74,percent of total billed charges,37.27% 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,5.02,40,,4.02,percent of total billed charges,40% of total billed charges,4.68,10.04,
PAMELOR 25MG CAP UD,6400014,CDM,250,RC,,,Outpatient,,,2.7,2.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,80,,1.73,percent of total billed charges,80% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% 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,1.08,40,,0.86,percent of total billed charges,40% of total billed charges,1.01,2.16,
PROCTOCREAM HC,6400014,CDM,250,RC,,,Outpatient,,,38.9,31.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.12,80,,24.9,percent of total billed charges,80% of total billed charges,14.5,37.27,,11.6,percent of total billed charges,37.27% of total billed charges,14.5,37.27,,11.6,percent of total billed charges,37.27% of total billed charges,14.5,37.27,,11.6,percent of total billed charges,37.27% 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,15.56,40,,12.45,percent of total billed charges,40% of total billed charges,14.5,31.12,
DEPAKOTE 250MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ORAJEL 1/16 OZ,6400014,CDM,250,RC,,,Outpatient,,,11.75,9.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.4,80,,7.52,percent of total billed charges,80% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% 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,4.7,40,,3.76,percent of total billed charges,40% of total billed charges,4.38,9.4,
PAVABID 150MG CAP,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
DIFLUCAN 100MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,37.17,29.74,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.74,80,,23.79,percent of total billed charges,80% of total billed charges,13.85,37.27,,11.08,percent of total billed charges,37.27% of total billed charges,13.85,37.27,,11.08,percent of total billed charges,37.27% of total billed charges,13.85,37.27,,11.08,percent of total billed charges,37.27% 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,14.87,40,,11.9,percent of total billed charges,40% of total billed charges,13.85,29.74,
PERI-COLACE GENERIC,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
IMITREX 50MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,77.95,62.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.36,80,,49.89,percent of total billed charges,80% of total billed charges,29.05,37.27,,23.24,percent of total billed charges,37.27% of total billed charges,29.05,37.27,,23.24,percent of total billed charges,37.27% of total billed charges,29.05,37.27,,23.24,percent of total billed charges,37.27% 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,31.18,40,,24.94,percent of total billed charges,40% of total billed charges,29.05,62.36,
CALAN SR 180MG,6400014,CDM,250,RC,,,Outpatient,,,3.75,3.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,80,,2.4,percent of total billed charges,80% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% 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,1.5,40,,1.2,percent of total billed charges,40% of total billed charges,1.4,3,
COSOPT EYE DROPS,6400014,CDM,250,RC,,,Outpatient,,,190.65,152.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152.52,80,,122.02,percent of total billed charges,80% of total billed charges,71.06,37.27,,56.85,percent of total billed charges,37.27% of total billed charges,71.06,37.27,,56.85,percent of total billed charges,37.27% of total billed charges,71.06,37.27,,56.85,percent of total billed charges,37.27% 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,76.26,40,,61.01,percent of total billed charges,40% of total billed charges,71.06,152.52,
TYLENOL 325MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
PRAVASHOL 10MG,6400014,CDM,250,RC,,,Outpatient,,,6.3,5.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,80,,4.03,percent of total billed charges,80% of total billed charges,2.35,37.27,,1.88,percent of total billed charges,37.27% of total billed charges,2.35,37.27,,1.88,percent of total billed charges,37.27% of total billed charges,2.35,37.27,,1.88,percent of total billed charges,37.27% 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,2.52,40,,2.02,percent of total billed charges,40% of total billed charges,2.35,5.04,
PHENOBARBITAL 30MG T,6400014,CDM,250,RC,,,Outpatient,,,2.95,2.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,80,,1.89,percent of total billed charges,80% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% 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,1.18,40,,0.94,percent of total billed charges,40% of total billed charges,1.1,2.36,
PHENOBARBITAL 60MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
PLACEBO ORAL,6400014,CDM,250,RC,,,Outpatient,,,5.6,4.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,80,,3.58,percent of total billed charges,80% of total billed charges,2.09,37.27,,1.67,percent of total billed charges,37.27% of total billed charges,2.09,37.27,,1.67,percent of total billed charges,37.27% of total billed charges,2.09,37.27,,1.67,percent of total billed charges,37.27% 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,2.24,40,,1.79,percent of total billed charges,40% of total billed charges,2.09,4.48,
POLY VI FLOR .5MG TA,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
OSMOLITE-HN,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
PREMARIN 0.3MG PO,6400014,CDM,250,RC,,,Outpatient,,,4.25,3.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.4,80,,2.72,percent of total billed charges,80% of total billed charges,1.58,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.58,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.58,37.27,,1.26,percent of total billed charges,37.27% 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,1.7,40,,1.36,percent of total billed charges,40% of total billed charges,1.58,3.4,
PREMARIN 0.625 MG PO,6400014,CDM,250,RC,,,Outpatient,,,28.25,22.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.6,80,,18.08,percent of total billed charges,80% of total billed charges,10.53,37.27,,8.42,percent of total billed charges,37.27% of total billed charges,10.53,37.27,,8.42,percent of total billed charges,37.27% of total billed charges,10.53,37.27,,8.42,percent of total billed charges,37.27% 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,11.3,40,,9.04,percent of total billed charges,40% of total billed charges,10.53,22.6,
PREMARIN 1.25 MG PO,6400014,CDM,250,RC,,,Outpatient,,,28.25,22.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.6,80,,18.08,percent of total billed charges,80% of total billed charges,10.53,37.27,,8.42,percent of total billed charges,37.27% of total billed charges,10.53,37.27,,8.42,percent of total billed charges,37.27% of total billed charges,10.53,37.27,,8.42,percent of total billed charges,37.27% 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,11.3,40,,9.04,percent of total billed charges,40% of total billed charges,10.53,22.6,
KLONOPIN TAB 0.5MG,6400014,CDM,250,RC,,,Outpatient,,,2.3,1.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.84,80,,1.47,percent of total billed charges,80% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% 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,0.92,40,,0.74,percent of total billed charges,40% of total billed charges,0.86,1.84,
STADOL NASAL SPRAY,6400014,CDM,250,RC,,,Outpatient,,,206.85,165.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165.48,80,,132.38,percent of total billed charges,80% of total billed charges,77.09,37.27,,61.67,percent of total billed charges,37.27% of total billed charges,77.09,37.27,,61.67,percent of total billed charges,37.27% of total billed charges,77.09,37.27,,61.67,percent of total billed charges,37.27% 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,82.74,40,,66.19,percent of total billed charges,40% of total billed charges,77.09,165.48,
PROLIXIN 1 MG,6400014,CDM,250,RC,,,Outpatient,,,2.4,1.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,80,,1.54,percent of total billed charges,80% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% 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,0.96,40,,0.77,percent of total billed charges,40% of total billed charges,0.89,1.92,
PROPYLTHIOURACIL 50M,6400014,CDM,250,RC,,,Outpatient,,,3.05,2.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.44,80,,1.95,percent of total billed charges,80% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% 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,1.22,40,,0.98,percent of total billed charges,40% of total billed charges,1.14,2.44,
PROVERA 10 MG,6400014,CDM,250,RC,,,Outpatient,,,2.5,2.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
PHENAZOPYRIDINE 100M,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
QUESTRAN LIGHT PKG,6400014,CDM,250,RC,,,Outpatient,,,17.4,13.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.92,80,,11.14,percent of total billed charges,80% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% 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,6.96,40,,5.57,percent of total billed charges,40% of total billed charges,6.48,13.92,
QUINAGLUTE DURATABS,6400014,CDM,250,RC,,,Outpatient,,,3.05,2.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.44,80,,1.95,percent of total billed charges,80% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% 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,1.22,40,,0.98,percent of total billed charges,40% of total billed charges,1.14,2.44,
QUININE SULFAT 260MG,6400014,CDM,250,RC,,,Outpatient,,,2.4,1.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,80,,1.54,percent of total billed charges,80% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% 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,0.96,40,,0.77,percent of total billed charges,40% of total billed charges,0.89,1.92,
ULTIVA 25MCG/ML SOLN,6400014,CDM,250,RC,,,Outpatient,,,3,2.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
REGLAN 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
RESTORIL 15MG CAP UD,6400014,CDM,250,RC,,,Outpatient,,,3.4,2.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.72,80,,2.18,percent of total billed charges,80% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% 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,1.36,40,,1.09,percent of total billed charges,40% of total billed charges,1.27,2.72,
RESTORIL 30MG CAP UD,6400014,CDM,250,RC,,,Outpatient,,,2.9,2.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.32,80,,1.86,percent of total billed charges,80% of total billed charges,1.08,37.27,,0.86,percent of total billed charges,37.27% of total billed charges,1.08,37.27,,0.86,percent of total billed charges,37.27% of total billed charges,1.08,37.27,,0.86,percent of total billed charges,37.27% 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,1.16,40,,0.93,percent of total billed charges,40% of total billed charges,1.08,2.32,
ROBAXIN 500MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ROBAXIN 750MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,2.45,1.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.96,80,,1.57,percent of total billed charges,80% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% 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,0.98,40,,0.78,percent of total billed charges,40% of total billed charges,0.91,1.96,
ROWASA ENEMA 60 ML,6400014,CDM,250,RC,,,Outpatient,,,80.2,64.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.16,80,,51.33,percent of total billed charges,80% of total billed charges,29.89,37.27,,23.91,percent of total billed charges,37.27% of total billed charges,29.89,37.27,,23.91,percent of total billed charges,37.27% of total billed charges,29.89,37.27,,23.91,percent of total billed charges,37.27% 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,32.08,40,,25.66,percent of total billed charges,40% of total billed charges,29.89,64.16,
PROCARDIA XL 30 MG,6400014,CDM,250,RC,,,Outpatient,,,4.35,3.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.48,80,,2.78,percent of total billed charges,80% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% 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,1.74,40,,1.39,percent of total billed charges,40% of total billed charges,1.62,3.48,
SENOKOT TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
SEPTRA DS TAB (COTRI,6400014,CDM,250,RC,,,Outpatient,,,3,2.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
SINEMET 25/100 TAB U,6400014,CDM,250,RC,,,Outpatient,,,2.5,2.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
SLOW-MAG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
SODIUM BICARBONATE 1,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CARISOPRODOL CPD TAB,6400014,CDM,250,RC,,,Outpatient,,,6.8,5.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,80,,4.35,percent of total billed charges,80% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% 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,2.72,40,,2.18,percent of total billed charges,40% of total billed charges,2.53,5.44,
STELAZINE 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.9,2.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.32,80,,1.86,percent of total billed charges,80% of total billed charges,1.08,37.27,,0.86,percent of total billed charges,37.27% of total billed charges,1.08,37.27,,0.86,percent of total billed charges,37.27% of total billed charges,1.08,37.27,,0.86,percent of total billed charges,37.27% 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,1.16,40,,0.93,percent of total billed charges,40% of total billed charges,1.08,2.32,
STRESSTABS-600 IRON,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
STRESSTABS-600 ZINC,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SURFAK 240MG CAP U/D,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SYNTHROID 0.025 MG T,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SYNTHROID 0.1MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.1,1.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,80,,1.34,percent of total billed charges,80% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% 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,0.84,40,,0.67,percent of total billed charges,40% of total billed charges,0.78,1.68,
SYNTHROID 0.2 MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
TALACEN TABLET U/D,6400014,CDM,250,RC,,,Outpatient,,,4,3.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
TESSALON PERLE 100MG,6400014,CDM,250,RC,,,Outpatient,,,2.35,1.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.88,80,,1.5,percent of total billed charges,80% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% 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,0.94,40,,0.75,percent of total billed charges,40% of total billed charges,0.88,1.88,
THEO-DUR 200MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,2.4,1.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,80,,1.54,percent of total billed charges,80% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% 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,0.96,40,,0.77,percent of total billed charges,40% of total billed charges,0.89,1.92,
THYROID 2GR,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
VERELAN 180MG CAP,6400014,CDM,250,RC,,,Outpatient,,,3.6,2.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,80,,2.3,percent of total billed charges,80% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% 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,1.44,40,,1.15,percent of total billed charges,40% of total billed charges,1.34,2.88,
TRIMPEX 100MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,7.9,6.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.32,80,,5.06,percent of total billed charges,80% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% 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,3.16,40,,2.53,percent of total billed charges,40% of total billed charges,2.94,6.32,
TYLENOL #4 TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
TYLENOL #3 TAB,6400014,CDM,250,RC,,,Outpatient,,,3.2,2.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,80,,2.05,percent of total billed charges,80% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% 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,1.28,40,,1.02,percent of total billed charges,40% of total billed charges,1.19,2.56,
URISED TAB,6400014,CDM,250,RC,,,Outpatient,,,2.7,2.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,80,,1.73,percent of total billed charges,80% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% 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,1.08,40,,0.86,percent of total billed charges,40% of total billed charges,1.01,2.16,
ANUSOL OINT 1 OZ,6400014,CDM,250,RC,,,Outpatient,,,14.3,11.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.44,80,,9.15,percent of total billed charges,80% of total billed charges,5.33,37.27,,4.26,percent of total billed charges,37.27% of total billed charges,5.33,37.27,,4.26,percent of total billed charges,37.27% of total billed charges,5.33,37.27,,4.26,percent of total billed charges,37.27% 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,5.72,40,,4.58,percent of total billed charges,40% of total billed charges,5.33,11.44,
HYDROCORTISONE CREAM,6400014,CDM,250,RC,,,Outpatient,,,37.5,30.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,80,,24,percent of total billed charges,80% of total billed charges,13.98,37.27,,11.18,percent of total billed charges,37.27% of total billed charges,13.98,37.27,,11.18,percent of total billed charges,37.27% of total billed charges,13.98,37.27,,11.18,percent of total billed charges,37.27% 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,15,40,,12,percent of total billed charges,40% of total billed charges,13.98,30,
JEVITY LIQUID,6400014,CDM,250,RC,,,Outpatient,,,8.1,6.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.48,80,,5.18,percent of total billed charges,80% of total billed charges,3.02,37.27,,2.42,percent of total billed charges,37.27% of total billed charges,3.02,37.27,,2.42,percent of total billed charges,37.27% of total billed charges,3.02,37.27,,2.42,percent of total billed charges,37.27% 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,3.24,40,,2.59,percent of total billed charges,40% of total billed charges,3.02,6.48,
JEVITY PLUS LIQUID,6400014,CDM,250,RC,,,Outpatient,,,9.75,7.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,80,,6.24,percent of total billed charges,80% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% 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,3.9,40,,3.12,percent of total billed charges,40% of total billed charges,3.63,7.8,
CEPHALEXIN CAP 250MG,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
VERELAN SR 240MG CAP,6400014,CDM,250,RC,,,Outpatient,,,3.9,3.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.12,80,,2.5,percent of total billed charges,80% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% 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,1.56,40,,1.25,percent of total billed charges,40% of total billed charges,1.45,3.12,
PRINZIDE 25,6400014,CDM,250,RC,,,Outpatient,,,4,3.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
DPIHENHYDRAMINE CAP,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
DIPHENHYDRAMINE CAP,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
LORAZEPAM TAB 0.5MG,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
ALLOPURINOL TAB 100M,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ZANTAC 150MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,5.35,4.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.28,80,,3.42,percent of total billed charges,80% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% 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,2.14,40,,1.71,percent of total billed charges,40% of total billed charges,1.99,4.28,
ZARONOLYN 2.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SIMETHECONE DROPS 40,6400014,CDM,250,RC,,,Outpatient,,,24.05,19.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.24,80,,15.39,percent of total billed charges,80% of total billed charges,8.96,37.27,,7.17,percent of total billed charges,37.27% of total billed charges,8.96,37.27,,7.17,percent of total billed charges,37.27% of total billed charges,8.96,37.27,,7.17,percent of total billed charges,37.27% 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,9.62,40,,7.7,percent of total billed charges,40% of total billed charges,8.96,19.24,
ADRENALIN 1MG,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
GAS RELIEF DROPS 40M,6400014,CDM,250,RC,,,Outpatient,,,19.63,15.70,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.7,80,,12.56,percent of total billed charges,80% of total billed charges,7.32,37.27,,5.86,percent of total billed charges,37.27% of total billed charges,7.32,37.27,,5.86,percent of total billed charges,37.27% of total billed charges,7.32,37.27,,5.86,percent of total billed charges,37.27% 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,7.85,40,,6.28,percent of total billed charges,40% of total billed charges,7.32,15.7,
AMINOCAPROIC ACID IN,6400014,CDM,250,RC,,,Outpatient,,,29.75,23.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.8,80,,19.04,percent of total billed charges,80% of total billed charges,11.09,37.27,,8.87,percent of total billed charges,37.27% of total billed charges,11.09,37.27,,8.87,percent of total billed charges,37.27% of total billed charges,11.09,37.27,,8.87,percent of total billed charges,37.27% 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,11.9,40,,9.52,percent of total billed charges,40% of total billed charges,11.09,23.8,
AMINOPHYLLINE 500MG/,6065130,CDM,636,RC,J0280,HCPCS,Outpatient,,,19.35,15.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.48,80,,12.38,percent of total billed charges,80% of total billed charges,7.21,37.27,,5.77,percent of total billed charges,37.27% of total billed charges,7.21,37.27,,5.77,percent of total billed charges,37.27% of total billed charges,7.21,37.27,,5.77,percent of total billed charges,37.27% 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,7.74,40,,6.19,percent of total billed charges,40% of total billed charges,7.21,15.48,
VITAMIN K 10MG AMP,6065130,CDM,636,RC,J3430,HCPCS,Outpatient,,,200.35,160.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.28,80,,128.22,percent of total billed charges,80% of total billed charges,74.67,37.27,,59.74,percent of total billed charges,37.27% of total billed charges,74.67,37.27,,59.74,percent of total billed charges,37.27% of total billed charges,74.67,37.27,,59.74,percent of total billed charges,37.27% 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,80.14,40,,64.11,percent of total billed charges,40% of total billed charges,74.67,160.28,
VITAMIN K 1MG/0.5ML,6065130,CDM,636,RC,J3430,HCPCS,Outpatient,,,101.15,80.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.92,80,,64.74,percent of total billed charges,80% of total billed charges,37.7,37.27,,30.16,percent of total billed charges,37.27% of total billed charges,37.7,37.27,,30.16,percent of total billed charges,37.27% of total billed charges,37.7,37.27,,30.16,percent of total billed charges,37.27% 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,40.46,40,,32.37,percent of total billed charges,40% of total billed charges,37.7,80.92,
LOPID 600MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
ATROPINE 0.4MG/ML 1C,6065130,CDM,636,RC,J0461,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
BENADRYL 50MG/CC,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
POTASSIUM PHOSPHATE,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
BRETHINE 1MG/ML,6065130,CDM,636,RC,J3105,HCPCS,Outpatient,,,107.2,85.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.76,80,,68.61,percent of total billed charges,80% of total billed charges,39.95,37.27,,31.96,percent of total billed charges,37.27% of total billed charges,39.95,37.27,,31.96,percent of total billed charges,37.27% of total billed charges,39.95,37.27,,31.96,percent of total billed charges,37.27% 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,42.88,40,,34.3,percent of total billed charges,40% of total billed charges,39.95,85.76,
BUMEX VIAL 0.5MG/2CC,6065130,CDM,636,RC,J1939,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
ZESTRIL 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
CALCIUM GLUCONATE 10,6065130,CDM,636,RC,J0613,HCPCS,Outpatient,,,22.1,17.68,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.68,80,,14.14,percent of total billed charges,80% of total billed charges,8.24,37.27,,6.59,percent of total billed charges,37.27% of total billed charges,8.24,37.27,,6.59,percent of total billed charges,37.27% of total billed charges,8.24,37.27,,6.59,percent of total billed charges,37.27% of total billed charges,0.07,100,,,fee schedule,100% of APC rate,0.07,100,,,fee schedule,100% of APC rate,0.07,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.07,100,,,fee schedule,100% of APC rate,0.07,100,,,fee schedule,100% of APC rate,0.07,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.84,40,,7.07,percent of total billed charges,40% of total billed charges,0.07,17.68,
BRONCHOLATE SYRUP,6400014,CDM,250,RC,,,Outpatient,,,7.05,5.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.64,80,,4.51,percent of total billed charges,80% of total billed charges,2.63,37.27,,2.1,percent of total billed charges,37.27% of total billed charges,2.63,37.27,,2.1,percent of total billed charges,37.27% of total billed charges,2.63,37.27,,2.1,percent of total billed charges,37.27% 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,2.82,40,,2.26,percent of total billed charges,40% of total billed charges,2.63,5.64,
CELESTONE SOLUSPAN,6065130,CDM,636,RC,J0702,HCPCS,Outpatient,,,15.3,12.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.24,80,,9.79,percent of total billed charges,80% of total billed charges,5.7,37.27,,4.56,percent of total billed charges,37.27% of total billed charges,5.7,37.27,,4.56,percent of total billed charges,37.27% of total billed charges,5.7,37.27,,4.56,percent of total billed charges,37.27% 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,6.12,40,,4.9,percent of total billed charges,40% of total billed charges,5.7,12.24,
PROCHLORPERAZINE 10M,6065130,CDM,636,RC,J0780,HCPCS,Outpatient,,,75.7,60.56,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.56,80,,48.45,percent of total billed charges,80% of total billed charges,28.21,37.27,,22.57,percent of total billed charges,37.27% of total billed charges,28.21,37.27,,22.57,percent of total billed charges,37.27% of total billed charges,28.21,37.27,,22.57,percent of total billed charges,37.27% 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,30.28,40,,24.22,percent of total billed charges,40% of total billed charges,28.21,60.56,
CALCIUM CHLORIDE 1GM,6400014,CDM,250,RC,,,Outpatient,,,69.95,55.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.96,80,,44.77,percent of total billed charges,80% of total billed charges,26.07,37.27,,20.86,percent of total billed charges,37.27% of total billed charges,26.07,37.27,,20.86,percent of total billed charges,37.27% of total billed charges,26.07,37.27,,20.86,percent of total billed charges,37.27% 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,27.98,40,,22.38,percent of total billed charges,40% of total billed charges,26.07,55.96,
D H E 45AMP,6065130,CDM,636,RC,J1110,HCPCS,Outpatient,,,537.5,430.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,430,80,,344,percent of total billed charges,80% of total billed charges,200.33,37.27,,160.26,percent of total billed charges,37.27% of total billed charges,200.33,37.27,,160.26,percent of total billed charges,37.27% of total billed charges,200.33,37.27,,160.26,percent of total billed charges,37.27% 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,215,40,,172,percent of total billed charges,40% of total billed charges,200.33,430,
RISPERDAL 1 MG,6400014,CDM,250,RC,,,Outpatient,,,10.9,8.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.72,80,,6.98,percent of total billed charges,80% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% 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,4.36,40,,3.49,percent of total billed charges,40% of total billed charges,4.06,8.72,
DECADRON LA 8MG,6400014,CDM,250,RC,,,Outpatient,,,32.6,26.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.08,80,,20.86,percent of total billed charges,80% of total billed charges,12.15,37.27,,9.72,percent of total billed charges,37.27% of total billed charges,12.15,37.27,,9.72,percent of total billed charges,37.27% of total billed charges,12.15,37.27,,9.72,percent of total billed charges,37.27% 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,13.04,40,,10.43,percent of total billed charges,40% of total billed charges,12.15,26.08,
MEGACE SUSP,6400014,CDM,250,RC,,,Outpatient,,,61.35,49.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.08,80,,39.26,percent of total billed charges,80% of total billed charges,22.87,37.27,,18.3,percent of total billed charges,37.27% of total billed charges,22.87,37.27,,18.3,percent of total billed charges,37.27% of total billed charges,22.87,37.27,,18.3,percent of total billed charges,37.27% 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,24.54,40,,19.63,percent of total billed charges,40% of total billed charges,22.87,49.08,
CORTANE-B OTIC,6400014,CDM,250,RC,,,Outpatient,,,99.65,79.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.72,80,,63.78,percent of total billed charges,80% of total billed charges,37.14,37.27,,29.71,percent of total billed charges,37.27% of total billed charges,37.14,37.27,,29.71,percent of total billed charges,37.27% of total billed charges,37.14,37.27,,29.71,percent of total billed charges,37.27% 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,39.86,40,,31.89,percent of total billed charges,40% of total billed charges,37.14,79.72,
DEPO-MEDROL CC 40 MG,6400014,CDM,250,RC,,,Outpatient,,,43.45,34.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.76,80,,27.81,percent of total billed charges,80% of total billed charges,16.19,37.27,,12.95,percent of total billed charges,37.27% of total billed charges,16.19,37.27,,12.95,percent of total billed charges,37.27% of total billed charges,16.19,37.27,,12.95,percent of total billed charges,37.27% 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,17.38,40,,13.9,percent of total billed charges,40% of total billed charges,16.19,34.76,
DEXTROSE 50%:50CCARB,6400014,CDM,250,RC,,,Outpatient,,,66.7,53.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.36,80,,42.69,percent of total billed charges,80% of total billed charges,24.86,37.27,,19.89,percent of total billed charges,37.27% of total billed charges,24.86,37.27,,19.89,percent of total billed charges,37.27% of total billed charges,24.86,37.27,,19.89,percent of total billed charges,37.27% 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,26.68,40,,21.34,percent of total billed charges,40% of total billed charges,24.86,53.36,
WELLBUTRIN XL 300MG,6400014,CDM,250,RC,,,Outpatient,,,29.6,23.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.68,80,,18.94,percent of total billed charges,80% of total billed charges,11.03,37.27,,8.82,percent of total billed charges,37.27% of total billed charges,11.03,37.27,,8.82,percent of total billed charges,37.27% of total billed charges,11.03,37.27,,8.82,percent of total billed charges,37.27% 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,11.84,40,,9.47,percent of total billed charges,40% of total billed charges,11.03,23.68,
DILANTIN 100MG/2CC I,6065130,CDM,636,RC,J1165,HCPCS,Outpatient,,,11.4,9.12,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
NIFEREX - 150 CAPSUL,6400014,CDM,250,RC,,,Outpatient,,,4.85,3.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.88,80,,3.1,percent of total billed charges,80% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% 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,1.94,40,,1.55,percent of total billed charges,40% of total billed charges,1.81,3.88,
TETANUS/DIPTHERIA PE,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
ZELNORM 6MG TAB,6400014,CDM,250,RC,,,Outpatient,,,12.6,10.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,80,,8.06,percent of total billed charges,80% of total billed charges,4.7,37.27,,3.76,percent of total billed charges,37.27% of total billed charges,4.7,37.27,,3.76,percent of total billed charges,37.27% of total billed charges,4.7,37.27,,3.76,percent of total billed charges,37.27% 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,5.04,40,,4.03,percent of total billed charges,40% of total billed charges,4.7,10.08,
EPHINEPHRINE 1MG SYR,6400014,CDM,250,RC,,,Outpatient,,,38.9,31.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.12,80,,24.9,percent of total billed charges,80% of total billed charges,14.5,37.27,,11.6,percent of total billed charges,37.27% of total billed charges,14.5,37.27,,11.6,percent of total billed charges,37.27% of total billed charges,14.5,37.27,,11.6,percent of total billed charges,37.27% 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,15.56,40,,12.45,percent of total billed charges,40% of total billed charges,14.5,31.12,
EPHEDRINE SULFATE 50,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
FLUOROURACIL:500MG/1,6065130,CDM,636,RC,J9190,HCPCS,Outpatient,,,12.95,10.36,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.36,80,,8.29,percent of total billed charges,80% of total billed charges,4.83,37.27,,3.86,percent of total billed charges,37.27% of total billed charges,4.83,37.27,,3.86,percent of total billed charges,37.27% of total billed charges,4.83,37.27,,3.86,percent of total billed charges,37.27% 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,5.18,40,,4.14,percent of total billed charges,40% of total billed charges,4.83,10.36,
GAMMA GLOBULIN VIAL,6400014,CDM,250,RC,,,Outpatient,,,57,45.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% 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,22.8,40,,18.24,percent of total billed charges,40% of total billed charges,21.24,45.6,
GLUCAGON INJ 1 MG,6065130,CDM,636,RC,J1610,HCPCS,Outpatient,,,1014.25,811.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,811.4,80,,649.12,percent of total billed charges,80% of total billed charges,378.01,37.27,,302.41,percent of total billed charges,37.27% of total billed charges,378.01,37.27,,302.41,percent of total billed charges,37.27% of total billed charges,378.01,37.27,,302.41,percent of total billed charges,37.27% of total billed charges,192.3,100,,,fee schedule,100% of APC rate,192.3,100,,,fee schedule,100% of APC rate,192.3,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,192.3,100,,,fee schedule,100% of APC rate,192.3,100,,,fee schedule,100% of APC rate,192.3,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.7,40,,324.56,percent of total billed charges,40% of total billed charges,192.3,811.4,
ZOFRAN 2MG/CC (PER C,6065130,CDM,636,RC,J2405,HCPCS,Outpatient,,,44.05,35.24,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.24,80,,28.19,percent of total billed charges,80% of total billed charges,16.42,37.27,,13.14,percent of total billed charges,37.27% of total billed charges,16.42,37.27,,13.14,percent of total billed charges,37.27% of total billed charges,16.42,37.27,,13.14,percent of total billed charges,37.27% 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,17.62,40,,14.1,percent of total billed charges,40% of total billed charges,16.42,35.24,
HALDOL INJ. 5MG/ML A,6065130,CDM,636,RC,J1630,HCPCS,Outpatient,,,18.3,14.64,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.64,80,,11.71,percent of total billed charges,80% of total billed charges,6.82,37.27,,5.46,percent of total billed charges,37.27% of total billed charges,6.82,37.27,,5.46,percent of total billed charges,37.27% of total billed charges,6.82,37.27,,5.46,percent of total billed charges,37.27% 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,7.32,40,,5.86,percent of total billed charges,40% of total billed charges,6.82,14.64,
"HEPARIN : 10,000 UN/",6065130,CDM,636,RC,J1644,HCPCS,Outpatient,,,25.35,20.28,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.28,80,,16.22,percent of total billed charges,80% of total billed charges,9.45,37.27,,7.56,percent of total billed charges,37.27% of total billed charges,9.45,37.27,,7.56,percent of total billed charges,37.27% of total billed charges,9.45,37.27,,7.56,percent of total billed charges,37.27% 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,10.14,40,,8.11,percent of total billed charges,40% of total billed charges,9.45,20.28,
"HEPARIN : 1,000 UN/M",6065130,CDM,636,RC,J1644,HCPCS,Outpatient,,,16.4,13.12,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,80,,10.5,percent of total billed charges,80% of total billed charges,6.11,37.27,,4.89,percent of total billed charges,37.27% of total billed charges,6.11,37.27,,4.89,percent of total billed charges,37.27% of total billed charges,6.11,37.27,,4.89,percent of total billed charges,37.27% 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,6.56,40,,5.25,percent of total billed charges,40% of total billed charges,6.11,13.12,
HEPARIN 1000 UNIT/CC,6065130,CDM,636,RC,J1644,HCPCS,Outpatient,,,20.15,16.12,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.12,80,,12.9,percent of total billed charges,80% of total billed charges,7.51,37.27,,6.01,percent of total billed charges,37.27% of total billed charges,7.51,37.27,,6.01,percent of total billed charges,37.27% of total billed charges,7.51,37.27,,6.01,percent of total billed charges,37.27% 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,8.06,40,,6.45,percent of total billed charges,40% of total billed charges,7.51,16.12,
"HEPARIN : 5,000 UN/M",6065130,CDM,636,RC,J1644,HCPCS,Outpatient,,,17.75,14.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.2,80,,11.36,percent of total billed charges,80% of total billed charges,6.62,37.27,,5.3,percent of total billed charges,37.27% of total billed charges,6.62,37.27,,5.3,percent of total billed charges,37.27% of total billed charges,6.62,37.27,,5.3,percent of total billed charges,37.27% 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,7.1,40,,5.68,percent of total billed charges,40% of total billed charges,6.62,14.2,
INFED,6065130,CDM,636,RC,J1750,HCPCS,Outpatient,,,115.35,92.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.28,80,,73.82,percent of total billed charges,80% of total billed charges,42.99,37.27,,34.39,percent of total billed charges,37.27% of total billed charges,42.99,37.27,,34.39,percent of total billed charges,37.27% of total billed charges,42.99,37.27,,34.39,percent of total billed charges,37.27% of total billed charges,17.67,100,,,fee schedule,100% of APC rate,17.67,100,,,fee schedule,100% of APC rate,17.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,17.67,100,,,fee schedule,100% of APC rate,17.67,100,,,fee schedule,100% of APC rate,17.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.14,40,,36.91,percent of total billed charges,40% of total billed charges,17.67,92.28,
MS CONTIN 15MG,6400014,CDM,250,RC,,,Outpatient,,,13.85,11.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.08,80,,8.86,percent of total billed charges,80% of total billed charges,5.16,37.27,,4.13,percent of total billed charges,37.27% of total billed charges,5.16,37.27,,4.13,percent of total billed charges,37.27% of total billed charges,5.16,37.27,,4.13,percent of total billed charges,37.27% 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,5.54,40,,4.43,percent of total billed charges,40% of total billed charges,5.16,11.08,
INDIGO CARMINE AMP,6400014,CDM,250,RC,,,Outpatient,,,680.55,544.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,544.44,80,,435.55,percent of total billed charges,80% of total billed charges,253.64,37.27,,202.91,percent of total billed charges,37.27% of total billed charges,253.64,37.27,,202.91,percent of total billed charges,37.27% of total billed charges,253.64,37.27,,202.91,percent of total billed charges,37.27% 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,272.22,40,,217.78,percent of total billed charges,40% of total billed charges,253.64,544.44,
KENALOG 40 MG 1CC,6065130,CDM,636,RC,J3301,HCPCS,Outpatient,,,38.3,30.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.64,80,,24.51,percent of total billed charges,80% of total billed charges,14.27,37.27,,11.42,percent of total billed charges,37.27% of total billed charges,14.27,37.27,,11.42,percent of total billed charges,37.27% of total billed charges,14.27,37.27,,11.42,percent of total billed charges,37.27% 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,15.32,40,,12.26,percent of total billed charges,40% of total billed charges,14.27,30.64,
FUROSEMIDE 40MG/4ML,6065130,CDM,636,RC,J1940,HCPCS,Outpatient,,,22.9,18.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.32,80,,14.66,percent of total billed charges,80% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% 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,9.16,40,,7.33,percent of total billed charges,40% of total billed charges,8.53,18.32,
FUROSEMIDE 100MG/10M,6065130,CDM,636,RC,J1940,HCPCS,Outpatient,,,68.8,55.04,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.04,80,,44.03,percent of total billed charges,80% of total billed charges,25.64,37.27,,20.51,percent of total billed charges,37.27% of total billed charges,25.64,37.27,,20.51,percent of total billed charges,37.27% of total billed charges,25.64,37.27,,20.51,percent of total billed charges,37.27% 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,27.52,40,,22.02,percent of total billed charges,40% of total billed charges,25.64,55.04,
LEVOPHED AMP,6400014,CDM,250,RC,,,Outpatient,,,82.75,66.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.2,80,,52.96,percent of total billed charges,80% of total billed charges,30.84,37.27,,24.67,percent of total billed charges,37.27% of total billed charges,30.84,37.27,,24.67,percent of total billed charges,37.27% of total billed charges,30.84,37.27,,24.67,percent of total billed charges,37.27% 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,33.1,40,,26.48,percent of total billed charges,40% of total billed charges,30.84,66.2,
LIDOCAINE CARDIAC SY,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,30.3,24.24,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.24,80,,19.39,percent of total billed charges,80% of total billed charges,11.29,37.27,,9.03,percent of total billed charges,37.27% of total billed charges,11.29,37.27,,9.03,percent of total billed charges,37.27% of total billed charges,11.29,37.27,,9.03,percent of total billed charges,37.27% 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,12.12,40,,9.7,percent of total billed charges,40% of total billed charges,11.29,24.24,
LOPRESSOR AMP 5MG/5C,6400014,CDM,250,RC,,,Outpatient,,,18.75,15.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15,80,,12,percent of total billed charges,80% of total billed charges,6.99,37.27,,5.59,percent of total billed charges,37.27% of total billed charges,6.99,37.27,,5.59,percent of total billed charges,37.27% of total billed charges,6.99,37.27,,5.59,percent of total billed charges,37.27% 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,7.5,40,,6,percent of total billed charges,40% of total billed charges,6.99,15,
MAG SULFATE 50% AMP,6065130,CDM,636,RC,J3475,HCPCS,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
MANNITOL 12.5GM (50C,6065130,CDM,636,RC,J2150,HCPCS,Outpatient,,,11.75,9.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.4,80,,7.52,percent of total billed charges,80% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% 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,4.7,40,,3.76,percent of total billed charges,40% of total billed charges,4.38,9.4,
METHERGINE 0.2MG/CC,6065130,CDM,636,RC,J2210,HCPCS,Outpatient,,,124.25,99.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.4,80,,79.52,percent of total billed charges,80% of total billed charges,46.31,37.27,,37.05,percent of total billed charges,37.27% of total billed charges,46.31,37.27,,37.05,percent of total billed charges,37.27% of total billed charges,46.31,37.27,,37.05,percent of total billed charges,37.27% 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,49.7,40,,39.76,percent of total billed charges,40% of total billed charges,46.31,99.4,
METHYLENE BLUE AMP,5880901,CDM,637,RC,,,Outpatient,,,606.05,484.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,484.84,80,,387.87,percent of total billed charges,80% of total billed charges,225.87,37.27,,180.7,percent of total billed charges,37.27% of total billed charges,225.87,37.27,,180.7,percent of total billed charges,37.27% of total billed charges,225.87,37.27,,180.7,percent of total billed charges,37.27% 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,242.42,40,,193.94,percent of total billed charges,40% of total billed charges,225.87,484.84,
METHOTREXATE 50MG/VI,6065130,CDM,636,RC,J9260,HCPCS,Outpatient,,,69.35,55.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.48,80,,44.38,percent of total billed charges,80% of total billed charges,25.85,37.27,,20.68,percent of total billed charges,37.27% of total billed charges,25.85,37.27,,20.68,percent of total billed charges,37.27% of total billed charges,25.85,37.27,,20.68,percent of total billed charges,37.27% 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,27.74,40,,22.19,percent of total billed charges,40% of total billed charges,25.85,55.48,
NEO-SYNEPHRINE AMP,6400014,CDM,250,RC,,,Outpatient,,,17.7,14.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.16,80,,11.33,percent of total billed charges,80% of total billed charges,6.6,37.27,,5.28,percent of total billed charges,37.27% of total billed charges,6.6,37.27,,5.28,percent of total billed charges,37.27% of total billed charges,6.6,37.27,,5.28,percent of total billed charges,37.27% 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,7.08,40,,5.66,percent of total billed charges,40% of total billed charges,6.6,14.16,
NORVASC 5MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,6.35,5.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.08,80,,4.06,percent of total billed charges,80% of total billed charges,2.37,37.27,,1.9,percent of total billed charges,37.27% of total billed charges,2.37,37.27,,1.9,percent of total billed charges,37.27% of total billed charges,2.37,37.27,,1.9,percent of total billed charges,37.27% 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,2.54,40,,2.03,percent of total billed charges,40% of total billed charges,2.37,5.08,
NITROPRESS 50MG INJ,6400014,CDM,250,RC,,,Outpatient,,,2327.9,1862.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1862.32,80,,1489.86,percent of total billed charges,80% of total billed charges,867.61,37.27,,694.09,percent of total billed charges,37.27% of total billed charges,867.61,37.27,,694.09,percent of total billed charges,37.27% of total billed charges,867.61,37.27,,694.09,percent of total billed charges,37.27% 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,931.16,40,,744.93,percent of total billed charges,40% of total billed charges,867.61,1862.32,
NORMODYNE VIAL 20ML,6065130,CDM,636,RC,J1920,HCPCS,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,0.27,100,,,fee schedule,100% of APC rate,0.27,100,,,fee schedule,100% of APC rate,0.27,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.27,100,,,fee schedule,100% of APC rate,0.27,100,,,fee schedule,100% of APC rate,0.27,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,0.27,10.16,
NUBAIN 1CC AMP (10MG,6065130,CDM,636,RC,J2300,HCPCS,Outpatient,,,12,9.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
PHENOBARBITAL AMP 13,6065130,CDM,636,RC,J2560,HCPCS,Outpatient,,,271.65,217.32,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,217.32,80,,173.86,percent of total billed charges,80% of total billed charges,101.24,37.27,,80.99,percent of total billed charges,37.27% of total billed charges,101.24,37.27,,80.99,percent of total billed charges,37.27% of total billed charges,101.24,37.27,,80.99,percent of total billed charges,37.27% 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,108.66,40,,86.93,percent of total billed charges,40% of total billed charges,101.24,217.32,
PITOCIN AMPS 10 UNIT,6065130,CDM,636,RC,J2590,HCPCS,Outpatient,,,15.45,12.36,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.36,80,,9.89,percent of total billed charges,80% of total billed charges,5.76,37.27,,4.61,percent of total billed charges,37.27% of total billed charges,5.76,37.27,,4.61,percent of total billed charges,37.27% of total billed charges,5.76,37.27,,4.61,percent of total billed charges,37.27% 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,6.18,40,,4.94,percent of total billed charges,40% of total billed charges,5.76,12.36,
PNEUMOCOCCAL VACCINE,6065130,CDM,636,RC,90732,HCPCS,Outpatient,,,845.75,676.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,676.6,80,,541.28,percent of total billed charges,80% of total billed charges,315.21,37.27,,252.17,percent of total billed charges,37.27% of total billed charges,315.21,37.27,,252.17,percent of total billed charges,37.27% of total billed charges,315.21,37.27,,252.17,percent of total billed charges,37.27% 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,338.3,40,,270.64,percent of total billed charges,40% of total billed charges,315.21,676.6,
POTASSIUM CHLORIDE :,6400014,CDM,250,RC,,,Outpatient,,,15.6,12.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.48,80,,9.98,percent of total billed charges,80% of total billed charges,5.81,37.27,,4.65,percent of total billed charges,37.27% of total billed charges,5.81,37.27,,4.65,percent of total billed charges,37.27% of total billed charges,5.81,37.27,,4.65,percent of total billed charges,37.27% 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,6.24,40,,4.99,percent of total billed charges,40% of total billed charges,5.81,12.48,
POTASSIUM CHLORIDE :,6400014,CDM,250,RC,,,Outpatient,,,20.65,16.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.52,80,,13.22,percent of total billed charges,80% of total billed charges,7.7,37.27,,6.16,percent of total billed charges,37.27% of total billed charges,7.7,37.27,,6.16,percent of total billed charges,37.27% of total billed charges,7.7,37.27,,6.16,percent of total billed charges,37.27% 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,8.26,40,,6.61,percent of total billed charges,40% of total billed charges,7.7,16.52,
PROLIXIN DECANOATE,6065130,CDM,636,RC,J2680,HCPCS,Outpatient,,,76.79,61.43,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.43,80,,49.14,percent of total billed charges,80% of total billed charges,28.62,37.27,,22.9,percent of total billed charges,37.27% of total billed charges,28.62,37.27,,22.9,percent of total billed charges,37.27% of total billed charges,28.62,37.27,,22.9,percent of total billed charges,37.27% 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,30.72,40,,24.58,percent of total billed charges,40% of total billed charges,28.62,61.43,
PROLIXIN 2.5MG/CC IM,6065130,CDM,636,RC,J2680,HCPCS,Outpatient,,,19.54,15.63,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.63,80,,12.5,percent of total billed charges,80% of total billed charges,7.28,37.27,,5.82,percent of total billed charges,37.27% of total billed charges,7.28,37.27,,5.82,percent of total billed charges,37.27% of total billed charges,7.28,37.27,,5.82,percent of total billed charges,37.27% 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,7.82,40,,6.26,percent of total billed charges,40% of total billed charges,7.28,15.63,
NEOSTIGMINE 1:1000,6065130,CDM,636,RC,J2710,HCPCS,Outpatient,,,11.75,9.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.4,80,,7.52,percent of total billed charges,80% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% 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,4.7,40,,3.76,percent of total billed charges,40% of total billed charges,4.38,9.4,
METOCLOPRAMIDE10 INJ,6065130,CDM,636,RC,J2765,HCPCS,Outpatient,,,13.7,10.96,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.96,80,,8.77,percent of total billed charges,80% of total billed charges,5.11,37.27,,4.09,percent of total billed charges,37.27% of total billed charges,5.11,37.27,,4.09,percent of total billed charges,37.27% of total billed charges,5.11,37.27,,4.09,percent of total billed charges,37.27% 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,5.48,40,,4.38,percent of total billed charges,40% of total billed charges,5.11,10.96,
BAYRHO-D,6065130,CDM,636,RC,J2790,HCPCS,Outpatient,,,430.15,344.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344.12,80,,275.3,percent of total billed charges,80% of total billed charges,160.32,37.27,,128.26,percent of total billed charges,37.27% of total billed charges,160.32,37.27,,128.26,percent of total billed charges,37.27% of total billed charges,160.32,37.27,,128.26,percent of total billed charges,37.27% 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,172.06,40,,137.65,percent of total billed charges,40% of total billed charges,160.32,344.12,
ROBAXIN VIAL :10ML,6065130,CDM,636,RC,J2800,HCPCS,Outpatient,,,270.35,216.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.28,80,,173.02,percent of total billed charges,80% of total billed charges,100.76,37.27,,80.61,percent of total billed charges,37.27% of total billed charges,100.76,37.27,,80.61,percent of total billed charges,37.27% of total billed charges,100.76,37.27,,80.61,percent of total billed charges,37.27% 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,108.14,40,,86.51,percent of total billed charges,40% of total billed charges,100.76,216.28,
VIOXX 50MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,15.21,12.17,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.17,80,,9.74,percent of total billed charges,80% of total billed charges,5.67,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.67,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.67,37.27,,4.54,percent of total billed charges,37.27% 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,6.08,40,,4.86,percent of total billed charges,40% of total billed charges,5.67,12.17,
ZOFRAN TAB 8MG,6400014,CDM,250,RC,,,Outpatient,,,129.1,103.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.28,80,,82.62,percent of total billed charges,80% of total billed charges,48.12,37.27,,38.5,percent of total billed charges,37.27% of total billed charges,48.12,37.27,,38.5,percent of total billed charges,37.27% of total billed charges,48.12,37.27,,38.5,percent of total billed charges,37.27% 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,51.64,40,,41.31,percent of total billed charges,40% of total billed charges,48.12,103.28,
SOD. BICARBONATE 8.4,6400014,CDM,250,RC,,,Outpatient,,,226.3,181.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.04,80,,144.83,percent of total billed charges,80% of total billed charges,84.34,37.27,,67.47,percent of total billed charges,37.27% of total billed charges,84.34,37.27,,67.47,percent of total billed charges,37.27% of total billed charges,84.34,37.27,,67.47,percent of total billed charges,37.27% 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,90.52,40,,72.42,percent of total billed charges,40% of total billed charges,84.34,181.04,
LOZOL 1.25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.05,1.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.64,80,,1.31,percent of total billed charges,80% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% 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,0.82,40,,0.66,percent of total billed charges,40% of total billed charges,0.76,1.64,
SOLU-CORTEF:100MG,6065130,CDM,636,RC,J1720,HCPCS,Outpatient,,,87.65,70.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.12,80,,56.1,percent of total billed charges,80% of total billed charges,32.67,37.27,,26.14,percent of total billed charges,37.27% of total billed charges,32.67,37.27,,26.14,percent of total billed charges,37.27% of total billed charges,32.67,37.27,,26.14,percent of total billed charges,37.27% 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,35.06,40,,28.05,percent of total billed charges,40% of total billed charges,32.67,70.12,
SOLU-CORTEF 250MG,6065130,CDM,636,RC,J1720,HCPCS,Outpatient,,,47,37.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% 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,18.8,40,,15.04,percent of total billed charges,40% of total billed charges,17.52,37.6,
SOLU-MEDROL 1000MG,6065130,CDM,636,RC,J2919,HCPCS,Outpatient,,,179.95,143.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.96,80,,115.17,percent of total billed charges,80% of total billed charges,67.07,37.27,,53.66,percent of total billed charges,37.27% of total billed charges,67.07,37.27,,53.66,percent of total billed charges,37.27% of total billed charges,67.07,37.27,,53.66,percent of total billed charges,37.27% 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,71.98,40,,57.58,percent of total billed charges,40% of total billed charges,67.07,143.96,
SOLU-MEDROL:125MG/2M,6065130,CDM,636,RC,J2919,HCPCS,Outpatient,,,47,37.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% 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,18.8,40,,15.04,percent of total billed charges,40% of total billed charges,17.52,37.6,
SOLU-MEDROL:PER 5MG,6065130,CDM,636,RC,J2919,HCPCS,Outpatient,,,26.8,21.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,80,,17.15,percent of total billed charges,80% of total billed charges,9.99,37.27,,7.99,percent of total billed charges,37.27% of total billed charges,9.99,37.27,,7.99,percent of total billed charges,37.27% of total billed charges,9.99,37.27,,7.99,percent of total billed charges,37.27% 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,10.72,40,,8.58,percent of total billed charges,40% of total billed charges,9.99,21.44,
SOLU-MEDROL 500MG,6065130,CDM,636,RC,J2919,HCPCS,Outpatient,,,113.6,90.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.88,80,,72.7,percent of total billed charges,80% of total billed charges,42.34,37.27,,33.87,percent of total billed charges,37.27% of total billed charges,42.34,37.27,,33.87,percent of total billed charges,37.27% of total billed charges,42.34,37.27,,33.87,percent of total billed charges,37.27% 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,45.44,40,,36.35,percent of total billed charges,40% of total billed charges,42.34,90.88,
DYTAN 25MG TABLET CH,6400014,CDM,250,RC,,,Outpatient,,,4.65,3.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.72,80,,2.98,percent of total billed charges,80% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% 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,1.86,40,,1.49,percent of total billed charges,40% of total billed charges,1.73,3.72,
LOTENSIN HCT TAB 10/,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SERZONE TAB 100MG,6400014,CDM,250,RC,,,Outpatient,,,13.05,10.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.44,80,,8.35,percent of total billed charges,80% of total billed charges,4.86,37.27,,3.89,percent of total billed charges,37.27% of total billed charges,4.86,37.27,,3.89,percent of total billed charges,37.27% of total billed charges,4.86,37.27,,3.89,percent of total billed charges,37.27% 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,5.22,40,,4.18,percent of total billed charges,40% of total billed charges,4.86,10.44,
GLUCOPHAGE XR 500MG,6400014,CDM,250,RC,,,Outpatient,,,4.55,3.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.64,80,,2.91,percent of total billed charges,80% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% 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,1.82,40,,1.46,percent of total billed charges,40% of total billed charges,1.7,3.64,
TETANUS IMMUNE GLOBU,6065130,CDM,636,RC,J1670,HCPCS,Outpatient,,,2344.8,1875.84,JG,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1875.84,80,,1500.67,percent of total billed charges,80% of total billed charges,873.91,37.27,,699.13,percent of total billed charges,37.27% of total billed charges,873.91,37.27,,699.13,percent of total billed charges,37.27% of total billed charges,873.91,37.27,,699.13,percent of total billed charges,37.27% of total billed charges,581.78,100,,,fee schedule,100% of APC rate,581.78,100,,,fee schedule,100% of APC rate,581.78,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,581.78,100,,,fee schedule,100% of APC rate,581.78,100,,,fee schedule,100% of APC rate,581.78,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,937.92,40,,750.34,percent of total billed charges,40% of total billed charges,581.78,1875.84,
TETANUS TOXOID,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
PAXIL 20MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,26.3,21.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.04,80,,16.83,percent of total billed charges,80% of total billed charges,9.8,37.27,,7.84,percent of total billed charges,37.27% of total billed charges,9.8,37.27,,7.84,percent of total billed charges,37.27% of total billed charges,9.8,37.27,,7.84,percent of total billed charges,37.27% 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,10.52,40,,8.42,percent of total billed charges,40% of total billed charges,9.8,21.04,
CALTRATE TAB 600MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
DIAZEPAM VIAL,6065130,CDM,636,RC,J3360,HCPCS,Outpatient,,,13.75,11.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11,80,,8.8,percent of total billed charges,80% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% 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,5.5,40,,4.4,percent of total billed charges,40% of total billed charges,5.12,11,
HYDROXYZINE 50MG INJ,6065130,CDM,636,RC,J3410,HCPCS,Outpatient,,,126.3,101.04,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.04,80,,80.83,percent of total billed charges,80% of total billed charges,47.07,37.27,,37.66,percent of total billed charges,37.27% of total billed charges,47.07,37.27,,37.66,percent of total billed charges,37.27% of total billed charges,47.07,37.27,,37.66,percent of total billed charges,37.27% 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,50.52,40,,40.42,percent of total billed charges,40% of total billed charges,47.07,101.04,
AVITENE NON-WOVEN,6400014,CDM,250,RC,,,Outpatient,,,335.35,268.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268.28,80,,214.62,percent of total billed charges,80% of total billed charges,124.98,37.27,,99.98,percent of total billed charges,37.27% of total billed charges,124.98,37.27,,99.98,percent of total billed charges,37.27% of total billed charges,124.98,37.27,,99.98,percent of total billed charges,37.27% 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,134.14,40,,107.31,percent of total billed charges,40% of total billed charges,124.98,268.28,
XYLOCAINE 1% 30CC AM,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,39.75,31.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,80,,25.44,percent of total billed charges,80% of total billed charges,14.81,37.27,,11.85,percent of total billed charges,37.27% of total billed charges,14.81,37.27,,11.85,percent of total billed charges,37.27% of total billed charges,14.81,37.27,,11.85,percent of total billed charges,37.27% 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,15.9,40,,12.72,percent of total billed charges,40% of total billed charges,14.81,31.8,
XYLOCAINE 1.5% 20ML,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,56.1,44.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.88,80,,35.9,percent of total billed charges,80% of total billed charges,20.91,37.27,,16.73,percent of total billed charges,37.27% of total billed charges,20.91,37.27,,16.73,percent of total billed charges,37.27% of total billed charges,20.91,37.27,,16.73,percent of total billed charges,37.27% 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,22.44,40,,17.95,percent of total billed charges,40% of total billed charges,20.91,44.88,
XYLOCAINE 4% 5ML AMP,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,19.75,15.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.8,80,,12.64,percent of total billed charges,80% of total billed charges,7.36,37.27,,5.89,percent of total billed charges,37.27% of total billed charges,7.36,37.27,,5.89,percent of total billed charges,37.27% of total billed charges,7.36,37.27,,5.89,percent of total billed charges,37.27% 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,7.9,40,,6.32,percent of total billed charges,40% of total billed charges,7.36,15.8,
XYLOCAINE 1% AMP 5ML,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,27.45,21.96,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.96,80,,17.57,percent of total billed charges,80% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% 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,10.98,40,,8.78,percent of total billed charges,40% of total billed charges,10.23,21.96,
ZANTAC INJ 50MG/2ML,6065130,CDM,636,RC,J2780,HCPCS,Outpatient,,,52.7,42.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.16,80,,33.73,percent of total billed charges,80% of total billed charges,19.64,37.27,,15.71,percent of total billed charges,37.27% of total billed charges,19.64,37.27,,15.71,percent of total billed charges,37.27% of total billed charges,19.64,37.27,,15.71,percent of total billed charges,37.27% 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,21.08,40,,16.86,percent of total billed charges,40% of total billed charges,19.64,42.16,
ANESTACON 15ML,6400014,CDM,250,RC,,,Outpatient,,,17.75,14.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.2,80,,11.36,percent of total billed charges,80% of total billed charges,6.62,37.27,,5.3,percent of total billed charges,37.27% of total billed charges,6.62,37.27,,5.3,percent of total billed charges,37.27% of total billed charges,6.62,37.27,,5.3,percent of total billed charges,37.27% 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,7.1,40,,5.68,percent of total billed charges,40% of total billed charges,6.62,14.2,
ALTACE 2.5MG CAP,6400014,CDM,250,RC,,,Outpatient,,,7.4,5.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.92,80,,4.74,percent of total billed charges,80% of total billed charges,2.76,37.27,,2.21,percent of total billed charges,37.27% of total billed charges,2.76,37.27,,2.21,percent of total billed charges,37.27% of total billed charges,2.76,37.27,,2.21,percent of total billed charges,37.27% 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,2.96,40,,2.37,percent of total billed charges,40% of total billed charges,2.76,5.92,
HYDROXYZINE HCL SYRU,6400014,CDM,250,RC,,,Outpatient,,,17.25,13.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,80,,11.04,percent of total billed charges,80% of total billed charges,6.43,37.27,,5.14,percent of total billed charges,37.27% of total billed charges,6.43,37.27,,5.14,percent of total billed charges,37.27% of total billed charges,6.43,37.27,,5.14,percent of total billed charges,37.27% 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,6.9,40,,5.52,percent of total billed charges,40% of total billed charges,6.43,13.8,
BENADRYL OZ,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
BENZOIN TINC,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
CASCARA FLUID EXTRAC,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
BENZOIN COMP,6400014,CDM,250,RC,,,Outpatient,,,22.8,18.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,80,,14.59,percent of total billed charges,80% of total billed charges,8.5,37.27,,6.8,percent of total billed charges,37.27% of total billed charges,8.5,37.27,,6.8,percent of total billed charges,37.27% of total billed charges,8.5,37.27,,6.8,percent of total billed charges,37.27% 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,9.12,40,,7.3,percent of total billed charges,40% of total billed charges,8.5,18.24,
DILANTIN 125MG/5CC S,6065130,CDM,636,RC,J1165,HCPCS,Outpatient,,,9.15,7.32,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.32,80,,5.86,percent of total billed charges,80% of total billed charges,3.41,37.27,,2.73,percent of total billed charges,37.27% of total billed charges,3.41,37.27,,2.73,percent of total billed charges,37.27% of total billed charges,3.41,37.27,,2.73,percent of total billed charges,37.27% 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,3.66,40,,2.93,percent of total billed charges,40% of total billed charges,3.41,7.32,
DILOR-G OZ,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
FLEETS PHOSPHO-SODA,5880901,CDM,637,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
PRINZIDE 12.5,6400014,CDM,250,RC,,,Outpatient,,,3.85,3.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.08,80,,2.46,percent of total billed charges,80% of total billed charges,1.43,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.43,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.43,37.27,,1.14,percent of total billed charges,37.27% 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,1.54,40,,1.23,percent of total billed charges,40% of total billed charges,1.43,3.08,
PRIMACOR IV 10 ML VI,6065130,CDM,636,RC,J2260,HCPCS,Outpatient,,,49.5,39.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.6,80,,31.68,percent of total billed charges,80% of total billed charges,18.45,37.27,,14.76,percent of total billed charges,37.27% of total billed charges,18.45,37.27,,14.76,percent of total billed charges,37.27% of total billed charges,18.45,37.27,,14.76,percent of total billed charges,37.27% 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,19.8,40,,15.84,percent of total billed charges,40% of total billed charges,18.45,39.6,
GLYCERIN OZ,6400014,CDM,250,RC,,,Outpatient,,,3.05,2.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.44,80,,1.95,percent of total billed charges,80% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% 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,1.22,40,,0.98,percent of total billed charges,40% of total billed charges,1.14,2.44,
POLY-VENT JR. 650/45,6400014,CDM,250,RC,,,Outpatient,,,3.35,2.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.68,80,,2.14,percent of total billed charges,80% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% 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,1.34,40,,1.07,percent of total billed charges,40% of total billed charges,1.25,2.68,
HYDROGEN PEROXIDE BO,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
KONDREMUL OZ,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
LEVSIN DROPS,6400014,CDM,250,RC,,,Outpatient,,,33,26.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% 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,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,12.3,26.4,
MAALOX 5OZ BOTTLE,6400014,CDM,250,RC,,,Outpatient,,,9.2,7.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,80,,5.89,percent of total billed charges,80% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% 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,3.68,40,,2.94,percent of total billed charges,40% of total billed charges,3.43,7.36,
MAALOX PLUS ANTACID,6400014,CDM,250,RC,,,Outpatient,,,9.2,7.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,80,,5.89,percent of total billed charges,80% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% 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,3.68,40,,2.94,percent of total billed charges,40% of total billed charges,3.43,7.36,
MAGNESIUM CITRATE 10,6400014,CDM,250,RC,,,Outpatient,,,12.25,9.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.8,80,,7.84,percent of total billed charges,80% of total billed charges,4.57,37.27,,3.66,percent of total billed charges,37.27% of total billed charges,4.57,37.27,,3.66,percent of total billed charges,37.27% of total billed charges,4.57,37.27,,3.66,percent of total billed charges,37.27% 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,4.9,40,,3.92,percent of total billed charges,40% of total billed charges,4.57,9.8,
MILK OF MAGNESIA 1OZ,6400014,CDM,250,RC,,,Outpatient,,,7.95,6.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.36,80,,5.09,percent of total billed charges,80% of total billed charges,2.96,37.27,,2.37,percent of total billed charges,37.27% of total billed charges,2.96,37.27,,2.37,percent of total billed charges,37.27% of total billed charges,2.96,37.27,,2.37,percent of total billed charges,37.27% 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,3.18,40,,2.54,percent of total billed charges,40% of total billed charges,2.96,6.36,
MINERAL OIL OZ,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
PAREGORIC OZ,6400014,CDM,250,RC,,,Outpatient,,,30.9,24.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.72,80,,19.78,percent of total billed charges,80% of total billed charges,11.52,37.27,,9.22,percent of total billed charges,37.27% of total billed charges,11.52,37.27,,9.22,percent of total billed charges,37.27% of total billed charges,11.52,37.27,,9.22,percent of total billed charges,37.27% 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,12.36,40,,9.89,percent of total billed charges,40% of total billed charges,11.52,24.72,
PEPTO BISMOL PER OZ,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PERDIEM GRANULES 250,6400014,CDM,250,RC,,,Outpatient,,,18.3,14.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.64,80,,11.71,percent of total billed charges,80% of total billed charges,6.82,37.27,,5.46,percent of total billed charges,37.27% of total billed charges,6.82,37.27,,5.46,percent of total billed charges,37.27% of total billed charges,6.82,37.27,,5.46,percent of total billed charges,37.27% 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,7.32,40,,5.86,percent of total billed charges,40% of total billed charges,6.82,14.64,
CIPRO IV 200MG,6065130,CDM,636,RC,J0744,HCPCS,Outpatient,,,129.6,103.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.68,80,,82.94,percent of total billed charges,80% of total billed charges,48.3,37.27,,38.64,percent of total billed charges,37.27% of total billed charges,48.3,37.27,,38.64,percent of total billed charges,37.27% of total billed charges,48.3,37.27,,38.64,percent of total billed charges,37.27% 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,51.84,40,,41.47,percent of total billed charges,40% of total billed charges,48.3,103.68,
PROMETHAZINE W/CODEI,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
PROMETHAZINE-VC PLAI,6400014,CDM,250,RC,,,Outpatient,,,19.15,15.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.32,80,,12.26,percent of total billed charges,80% of total billed charges,7.14,37.27,,5.71,percent of total billed charges,37.27% of total billed charges,7.14,37.27,,5.71,percent of total billed charges,37.27% of total billed charges,7.14,37.27,,5.71,percent of total billed charges,37.27% 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,7.66,40,,6.13,percent of total billed charges,40% of total billed charges,7.14,15.32,
PROMETHAZINE-VC W/CO,6400014,CDM,250,RC,,,Outpatient,,,11.95,9.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.56,80,,7.65,percent of total billed charges,80% of total billed charges,4.45,37.27,,3.56,percent of total billed charges,37.27% of total billed charges,4.45,37.27,,3.56,percent of total billed charges,37.27% of total billed charges,4.45,37.27,,3.56,percent of total billed charges,37.27% 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,4.78,40,,3.82,percent of total billed charges,40% of total billed charges,4.45,9.56,
CIPRO IV 400MG 40ML,6065130,CDM,636,RC,J0744,HCPCS,Outpatient,,,259.2,207.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.36,80,,165.89,percent of total billed charges,80% of total billed charges,96.6,37.27,,77.28,percent of total billed charges,37.27% of total billed charges,96.6,37.27,,77.28,percent of total billed charges,37.27% of total billed charges,96.6,37.27,,77.28,percent of total billed charges,37.27% 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,103.68,40,,82.94,percent of total billed charges,40% of total billed charges,96.6,207.36,
TICLID 250MG,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
SCOPE 6 OZ,5828504,CDM,990,RC,,,Outpatient,,,6.05,4.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,80,,3.87,percent of total billed charges,80% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% 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,2.42,40,,1.94,percent of total billed charges,40% of total billed charges,2.25,4.84,
TORADOL 60MG/2ML INJ,6065130,CDM,636,RC,J1885,HCPCS,Outpatient,,,31.75,25.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.4,80,,20.32,percent of total billed charges,80% of total billed charges,11.83,37.27,,9.46,percent of total billed charges,37.27% of total billed charges,11.83,37.27,,9.46,percent of total billed charges,37.27% of total billed charges,11.83,37.27,,9.46,percent of total billed charges,37.27% 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,12.7,40,,10.16,percent of total billed charges,40% of total billed charges,11.83,25.4,
TUSSIONEX OZ,6400014,CDM,250,RC,,,Outpatient,,,84.95,67.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.96,80,,54.37,percent of total billed charges,80% of total billed charges,31.66,37.27,,25.33,percent of total billed charges,37.27% of total billed charges,31.66,37.27,,25.33,percent of total billed charges,37.27% of total billed charges,31.66,37.27,,25.33,percent of total billed charges,37.27% 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,33.98,40,,27.18,percent of total billed charges,40% of total billed charges,31.66,67.96,
TYLENOL ELIXIR 160MG,6400014,CDM,250,RC,,,Outpatient,,,133.9,107.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.12,80,,85.7,percent of total billed charges,80% of total billed charges,49.9,37.27,,39.92,percent of total billed charges,37.27% of total billed charges,49.9,37.27,,39.92,percent of total billed charges,37.27% of total billed charges,49.9,37.27,,39.92,percent of total billed charges,37.27% 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,53.56,40,,42.85,percent of total billed charges,40% of total billed charges,49.9,107.12,
LIDOCAINE VISCOUS 10,5880901,CDM,637,RC,,,Outpatient,,,45,36.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% 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,18,40,,14.4,percent of total billed charges,40% of total billed charges,16.77,36,
LIDOCAINE VISCOUS 2%,5880901,CDM,637,RC,,,Outpatient,,,9.7,7.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.76,80,,6.21,percent of total billed charges,80% of total billed charges,3.62,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.62,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.62,37.27,,2.9,percent of total billed charges,37.27% 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,3.88,40,,3.1,percent of total billed charges,40% of total billed charges,3.62,7.76,
LTA KIT (PRE-ATTACHE,5880901,CDM,637,RC,,,Outpatient,,,30.9,24.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.72,80,,19.78,percent of total billed charges,80% of total billed charges,11.52,37.27,,9.22,percent of total billed charges,37.27% of total billed charges,11.52,37.27,,9.22,percent of total billed charges,37.27% of total billed charges,11.52,37.27,,9.22,percent of total billed charges,37.27% 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,12.36,40,,9.89,percent of total billed charges,40% of total billed charges,11.52,24.72,
AMOXIL SUSP 125MG/5M,6400014,CDM,250,RC,,,Outpatient,,,3.85,3.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.08,80,,2.46,percent of total billed charges,80% of total billed charges,1.43,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.43,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.43,37.27,,1.14,percent of total billed charges,37.27% 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,1.54,40,,1.23,percent of total billed charges,40% of total billed charges,1.43,3.08,
AUGMENTIN 500MG TAB,6400014,CDM,250,RC,,,Outpatient,,,23.55,18.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.84,80,,15.07,percent of total billed charges,80% of total billed charges,8.78,37.27,,7.02,percent of total billed charges,37.27% of total billed charges,8.78,37.27,,7.02,percent of total billed charges,37.27% of total billed charges,8.78,37.27,,7.02,percent of total billed charges,37.27% 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,9.42,40,,7.54,percent of total billed charges,40% of total billed charges,8.78,18.84,
AUGMENTIN SUSP 250MG,6400014,CDM,250,RC,,,Outpatient,,,79.25,63.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.4,80,,50.72,percent of total billed charges,80% of total billed charges,29.54,37.27,,23.63,percent of total billed charges,37.27% of total billed charges,29.54,37.27,,23.63,percent of total billed charges,37.27% of total billed charges,29.54,37.27,,23.63,percent of total billed charges,37.27% 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,31.7,40,,25.36,percent of total billed charges,40% of total billed charges,29.54,63.4,
BICILLIN-CR,6400014,CDM,250,RC,J0558,HCPCS,Outpatient,,,41.45,33.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.16,80,,26.53,percent of total billed charges,80% of total billed charges,15.45,37.27,,12.36,percent of total billed charges,37.27% of total billed charges,15.45,37.27,,12.36,percent of total billed charges,37.27% of total billed charges,15.45,37.27,,12.36,percent of total billed charges,37.27% of total billed charges,19.52,100,,,fee schedule,100% of APC rate,19.52,100,,,fee schedule,100% of APC rate,19.52,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,19.52,100,,,fee schedule,100% of APC rate,19.52,100,,,fee schedule,100% of APC rate,19.52,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.58,40,,13.26,percent of total billed charges,40% of total billed charges,15.45,33.16,
BICILLIN-LA 1200000,6065130,CDM,636,RC,J0561,HCPCS,Outpatient,,,56.16,44.93,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.93,80,,35.94,percent of total billed charges,80% of total billed charges,20.93,37.27,,16.74,percent of total billed charges,37.27% of total billed charges,20.93,37.27,,16.74,percent of total billed charges,37.27% of total billed charges,20.93,37.27,,16.74,percent of total billed charges,37.27% of total billed charges,24.37,100,,,fee schedule,100% of APC rate,24.37,100,,,fee schedule,100% of APC rate,24.37,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,24.37,100,,,fee schedule,100% of APC rate,24.37,100,,,fee schedule,100% of APC rate,24.37,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.46,40,,17.97,percent of total billed charges,40% of total billed charges,20.93,44.93,
CECLOR 250MG CAP,6400014,CDM,250,RC,,,Outpatient,,,7.1,5.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.68,80,,4.54,percent of total billed charges,80% of total billed charges,2.65,37.27,,2.12,percent of total billed charges,37.27% of total billed charges,2.65,37.27,,2.12,percent of total billed charges,37.27% of total billed charges,2.65,37.27,,2.12,percent of total billed charges,37.27% 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,2.84,40,,2.27,percent of total billed charges,40% of total billed charges,2.65,5.68,
PEPTO BISMOL TAB,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
CHLOROMYCETIN,6065130,CDM,636,RC,J0720,HCPCS,Outpatient,,,39.65,31.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.72,80,,25.38,percent of total billed charges,80% of total billed charges,14.78,37.27,,11.82,percent of total billed charges,37.27% of total billed charges,14.78,37.27,,11.82,percent of total billed charges,37.27% of total billed charges,14.78,37.27,,11.82,percent of total billed charges,37.27% 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,15.86,40,,12.69,percent of total billed charges,40% of total billed charges,14.78,31.72,
EFFEXOR XR 37.5 MG C,6400014,CDM,250,RC,,,Outpatient,,,17.65,14.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.12,80,,11.3,percent of total billed charges,80% of total billed charges,6.58,37.27,,5.26,percent of total billed charges,37.27% of total billed charges,6.58,37.27,,5.26,percent of total billed charges,37.27% of total billed charges,6.58,37.27,,5.26,percent of total billed charges,37.27% 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,7.06,40,,5.65,percent of total billed charges,40% of total billed charges,6.58,14.12,
CLAFORAN : 1GM IV,6065130,CDM,636,RC,J0698,HCPCS,Outpatient,,,57.15,45.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.72,80,,36.58,percent of total billed charges,80% of total billed charges,21.3,37.27,,17.04,percent of total billed charges,37.27% of total billed charges,21.3,37.27,,17.04,percent of total billed charges,37.27% of total billed charges,21.3,37.27,,17.04,percent of total billed charges,37.27% 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,22.86,40,,18.29,percent of total billed charges,40% of total billed charges,21.3,45.72,
CLAFORAN : 2GM IV,6065130,CDM,636,RC,J0698,HCPCS,Outpatient,,,103.7,82.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.96,80,,66.37,percent of total billed charges,80% of total billed charges,38.65,37.27,,30.92,percent of total billed charges,37.27% of total billed charges,38.65,37.27,,30.92,percent of total billed charges,37.27% of total billed charges,38.65,37.27,,30.92,percent of total billed charges,37.27% 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,41.48,40,,33.18,percent of total billed charges,40% of total billed charges,38.65,82.96,
CLEOCIN : 600MG IM/I,6400014,CDM,250,RC,,,Outpatient,,,57.15,45.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.72,80,,36.58,percent of total billed charges,80% of total billed charges,21.3,37.27,,17.04,percent of total billed charges,37.27% of total billed charges,21.3,37.27,,17.04,percent of total billed charges,37.27% of total billed charges,21.3,37.27,,17.04,percent of total billed charges,37.27% 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,22.86,40,,18.29,percent of total billed charges,40% of total billed charges,21.3,45.72,
CLEOCIN SUSP 100CC,6400014,CDM,250,RC,,,Outpatient,,,225.15,180.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180.12,80,,144.1,percent of total billed charges,80% of total billed charges,83.91,37.27,,67.13,percent of total billed charges,37.27% of total billed charges,83.91,37.27,,67.13,percent of total billed charges,37.27% of total billed charges,83.91,37.27,,67.13,percent of total billed charges,37.27% 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,90.06,40,,72.05,percent of total billed charges,40% of total billed charges,83.91,180.12,
CLEOCIN 150 MG CAP,6400014,CDM,250,RC,,,Outpatient,,,4.2,3.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.36,80,,2.69,percent of total billed charges,80% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% 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,1.68,40,,1.34,percent of total billed charges,40% of total billed charges,1.57,3.36,
DURICEF 500MG CAPS,6400014,CDM,250,RC,,,Outpatient,,,10.85,8.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.68,80,,6.94,percent of total billed charges,80% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% 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,4.34,40,,3.47,percent of total billed charges,40% of total billed charges,4.04,8.68,
E-MYCIN 250MG TAB,6400014,CDM,250,RC,,,Outpatient,,,54.4,43.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,80,,34.82,percent of total billed charges,80% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% 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,21.76,40,,17.41,percent of total billed charges,40% of total billed charges,20.27,43.52,
E-MYCIN 333,6400014,CDM,250,RC,,,Outpatient,,,4.9,3.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.92,80,,3.14,percent of total billed charges,80% of total billed charges,1.83,37.27,,1.46,percent of total billed charges,37.27% of total billed charges,1.83,37.27,,1.46,percent of total billed charges,37.27% of total billed charges,1.83,37.27,,1.46,percent of total billed charges,37.27% 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,1.96,40,,1.57,percent of total billed charges,40% of total billed charges,1.83,3.92,
METRONIDAZOLE 500MG/,6065130,CDM,636,RC,J1836,HCPCS,Outpatient,,,52.3,41.84,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.84,80,,33.47,percent of total billed charges,80% of total billed charges,19.49,37.27,,15.59,percent of total billed charges,37.27% of total billed charges,19.49,37.27,,15.59,percent of total billed charges,37.27% of total billed charges,19.49,37.27,,15.59,percent of total billed charges,37.27% of total billed charges,0.03,100,,,fee schedule,100% of APC rate,0.03,100,,,fee schedule,100% of APC rate,0.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.03,100,,,fee schedule,100% of APC rate,0.03,100,,,fee schedule,100% of APC rate,0.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.92,40,,16.74,percent of total billed charges,40% of total billed charges,0.03,41.84,
FUNGIZONE INJ.:50MG,6065130,CDM,636,RC,J0285,HCPCS,Outpatient,,,136.05,108.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.84,80,,87.07,percent of total billed charges,80% of total billed charges,50.71,37.27,,40.57,percent of total billed charges,37.27% of total billed charges,50.71,37.27,,40.57,percent of total billed charges,37.27% of total billed charges,50.71,37.27,,40.57,percent of total billed charges,37.27% 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,54.42,40,,43.54,percent of total billed charges,40% of total billed charges,50.71,108.84,
GENTAMICIN 20MG PED,6065130,CDM,636,RC,J1580,HCPCS,Outpatient,,,38.95,31.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.16,80,,24.93,percent of total billed charges,80% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% 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,15.58,40,,12.46,percent of total billed charges,40% of total billed charges,14.52,31.16,
DIFLUCAN 150MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,59.15,47.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.32,80,,37.86,percent of total billed charges,80% of total billed charges,22.05,37.27,,17.64,percent of total billed charges,37.27% of total billed charges,22.05,37.27,,17.64,percent of total billed charges,37.27% of total billed charges,22.05,37.27,,17.64,percent of total billed charges,37.27% 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,23.66,40,,18.93,percent of total billed charges,40% of total billed charges,22.05,47.32,
ZANTAC 75MG (RANTIDI,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
AUGMENTIN 875MG TAB,6400014,CDM,250,RC,,,Outpatient,,,31.45,25.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.16,80,,20.13,percent of total billed charges,80% of total billed charges,11.72,37.27,,9.38,percent of total billed charges,37.27% of total billed charges,11.72,37.27,,9.38,percent of total billed charges,37.27% of total billed charges,11.72,37.27,,9.38,percent of total billed charges,37.27% 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,12.58,40,,10.06,percent of total billed charges,40% of total billed charges,11.72,25.16,
OXYCONTIN 10MG TAB (,6400014,CDM,250,RC,,,Outpatient,,,21.85,17.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.48,80,,13.98,percent of total billed charges,80% of total billed charges,8.14,37.27,,6.51,percent of total billed charges,37.27% of total billed charges,8.14,37.27,,6.51,percent of total billed charges,37.27% of total billed charges,8.14,37.27,,6.51,percent of total billed charges,37.27% 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,8.74,40,,6.99,percent of total billed charges,40% of total billed charges,8.14,17.48,
KANTREX 1.0GM INJ,6065130,CDM,636,RC,J1840,HCPCS,Outpatient,,,96.85,77.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.48,80,,61.98,percent of total billed charges,80% of total billed charges,36.1,37.27,,28.88,percent of total billed charges,37.27% of total billed charges,36.1,37.27,,28.88,percent of total billed charges,37.27% of total billed charges,36.1,37.27,,28.88,percent of total billed charges,37.27% 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,38.74,40,,30.99,percent of total billed charges,40% of total billed charges,36.1,77.48,
KEFLEX 250MG CAP,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
NAFCILLIN 1GM INJ,6400014,CDM,250,RC,,,Outpatient,,,49.8,39.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.84,80,,31.87,percent of total billed charges,80% of total billed charges,18.56,37.27,,14.85,percent of total billed charges,37.27% of total billed charges,18.56,37.27,,14.85,percent of total billed charges,37.27% of total billed charges,18.56,37.27,,14.85,percent of total billed charges,37.27% 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,19.92,40,,15.94,percent of total billed charges,40% of total billed charges,18.56,39.84,
NAFCILLIN 2GM INJ,6400014,CDM,250,RC,,,Outpatient,,,68.55,54.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.84,80,,43.87,percent of total billed charges,80% of total billed charges,25.55,37.27,,20.44,percent of total billed charges,37.27% of total billed charges,25.55,37.27,,20.44,percent of total billed charges,37.27% of total billed charges,25.55,37.27,,20.44,percent of total billed charges,37.27% 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,27.42,40,,21.94,percent of total billed charges,40% of total billed charges,25.55,54.84,
NEBCIN (TOBRAMYCIN),6065130,CDM,636,RC,J3260,HCPCS,Outpatient,,,45.15,36.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.12,80,,28.9,percent of total billed charges,80% of total billed charges,16.83,37.27,,13.46,percent of total billed charges,37.27% of total billed charges,16.83,37.27,,13.46,percent of total billed charges,37.27% of total billed charges,16.83,37.27,,13.46,percent of total billed charges,37.27% 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,18.06,40,,14.45,percent of total billed charges,40% of total billed charges,16.83,36.12,
NEOMYCIN SULFATE 500,6400014,CDM,250,RC,,,Outpatient,,,5.8,4.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.64,80,,3.71,percent of total billed charges,80% of total billed charges,2.16,37.27,,1.73,percent of total billed charges,37.27% of total billed charges,2.16,37.27,,1.73,percent of total billed charges,37.27% of total billed charges,2.16,37.27,,1.73,percent of total billed charges,37.27% 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,2.32,40,,1.86,percent of total billed charges,40% of total billed charges,2.16,4.64,
NEOSPORIN GU AMP,6400014,CDM,250,RC,,,Outpatient,,,97.35,77.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.88,80,,62.3,percent of total billed charges,80% of total billed charges,36.28,37.27,,29.02,percent of total billed charges,37.27% of total billed charges,36.28,37.27,,29.02,percent of total billed charges,37.27% of total billed charges,36.28,37.27,,29.02,percent of total billed charges,37.27% 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,38.94,40,,31.15,percent of total billed charges,40% of total billed charges,36.28,77.88,
NILSTAT ORAL,6400014,CDM,250,RC,,,Outpatient,,,63.85,51.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.08,80,,40.86,percent of total billed charges,80% of total billed charges,23.8,37.27,,19.04,percent of total billed charges,37.27% of total billed charges,23.8,37.27,,19.04,percent of total billed charges,37.27% of total billed charges,23.8,37.27,,19.04,percent of total billed charges,37.27% 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,25.54,40,,20.43,percent of total billed charges,40% of total billed charges,23.8,51.08,
MOTRIN SUSP 100MG/5M,5880901,CDM,637,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
KEFLEX 500MG CAP,6400014,CDM,250,RC,,,Outpatient,,,9.6,7.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,80,,6.14,percent of total billed charges,80% of total billed charges,3.58,37.27,,2.86,percent of total billed charges,37.27% of total billed charges,3.58,37.27,,2.86,percent of total billed charges,37.27% of total billed charges,3.58,37.27,,2.86,percent of total billed charges,37.27% 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,3.84,40,,3.07,percent of total billed charges,40% of total billed charges,3.58,7.68,
PFIZERPEN:500000 UNI,6400014,CDM,250,RC,,,Outpatient,,,16.75,13.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.4,80,,10.72,percent of total billed charges,80% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% 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,6.7,40,,5.36,percent of total billed charges,40% of total billed charges,6.24,13.4,
AMPICILLIN SUSP 125M,6400014,CDM,250,RC,,,Outpatient,,,23.5,18.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.8,80,,15.04,percent of total billed charges,80% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% 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,9.4,40,,7.52,percent of total billed charges,40% of total billed charges,8.76,18.8,
AMPICILLIN SUSP 250M,6400014,CDM,250,RC,,,Outpatient,,,22.8,18.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,80,,14.59,percent of total billed charges,80% of total billed charges,8.5,37.27,,6.8,percent of total billed charges,37.27% of total billed charges,8.5,37.27,,6.8,percent of total billed charges,37.27% of total billed charges,8.5,37.27,,6.8,percent of total billed charges,37.27% 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,9.12,40,,7.3,percent of total billed charges,40% of total billed charges,8.5,18.24,
POLYCILLIN 500MG CAP,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
PRINCIPEN SUSP 250MG,6400014,CDM,250,RC,,,Outpatient,,,24.35,19.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.48,80,,15.58,percent of total billed charges,80% of total billed charges,9.08,37.27,,7.26,percent of total billed charges,37.27% of total billed charges,9.08,37.27,,7.26,percent of total billed charges,37.27% of total billed charges,9.08,37.27,,7.26,percent of total billed charges,37.27% 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,9.74,40,,7.79,percent of total billed charges,40% of total billed charges,9.08,19.48,
RIFADIN 300MG CAPSUL,6400014,CDM,250,RC,,,Outpatient,,,7.85,6.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.28,80,,5.02,percent of total billed charges,80% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% 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,3.14,40,,2.51,percent of total billed charges,40% of total billed charges,2.93,6.28,
ROCEPHIN:1GM IV/IM,6065130,CDM,636,RC,J0696,HCPCS,Outpatient,,,54.4,43.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,80,,34.82,percent of total billed charges,80% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% 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,21.76,40,,17.41,percent of total billed charges,40% of total billed charges,20.27,43.52,
SUMYCIN 250 MG CAP,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
TETRACYCLINE 500MG C,6400014,CDM,250,RC,,,Outpatient,,,61.6,49.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.28,80,,39.42,percent of total billed charges,80% of total billed charges,22.96,37.27,,18.37,percent of total billed charges,37.27% of total billed charges,22.96,37.27,,18.37,percent of total billed charges,37.27% of total billed charges,22.96,37.27,,18.37,percent of total billed charges,37.27% 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,24.64,40,,19.71,percent of total billed charges,40% of total billed charges,22.96,49.28,
EUCERIN CREME,6400014,CDM,250,RC,,,Outpatient,,,22.58,18.06,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.06,80,,14.45,percent of total billed charges,80% of total billed charges,8.42,37.27,,6.74,percent of total billed charges,37.27% of total billed charges,8.42,37.27,,6.74,percent of total billed charges,37.27% of total billed charges,8.42,37.27,,6.74,percent of total billed charges,37.27% 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,9.03,40,,7.22,percent of total billed charges,40% of total billed charges,8.42,18.06,
GLUCOPHAGE TAB 500MG,6400014,CDM,250,RC,,,Outpatient,,,2.6,2.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.08,80,,1.66,percent of total billed charges,80% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% 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,1.04,40,,0.83,percent of total billed charges,40% of total billed charges,0.97,2.08,
VANCOMYCIN IV 500MG,6065130,CDM,636,RC,J3370,HCPCS,Outpatient,,,102.95,82.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.36,80,,65.89,percent of total billed charges,80% of total billed charges,38.37,37.27,,30.7,percent of total billed charges,37.27% of total billed charges,38.37,37.27,,30.7,percent of total billed charges,37.27% of total billed charges,38.37,37.27,,30.7,percent of total billed charges,37.27% 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,41.18,40,,32.94,percent of total billed charges,40% of total billed charges,38.37,82.36,
PENICILLIN VK 250MG,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
VIBRAMYCIN ORAL SUSP,6400014,CDM,250,RC,,,Outpatient,,,124.95,99.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.96,80,,79.97,percent of total billed charges,80% of total billed charges,46.57,37.27,,37.26,percent of total billed charges,37.27% of total billed charges,46.57,37.27,,37.26,percent of total billed charges,37.27% of total billed charges,46.57,37.27,,37.26,percent of total billed charges,37.27% 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,49.98,40,,39.98,percent of total billed charges,40% of total billed charges,46.57,99.96,
ZINACEF:750MG INJ,6065130,CDM,636,RC,J0697,HCPCS,Outpatient,,,37.35,29.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.88,80,,23.9,percent of total billed charges,80% of total billed charges,13.92,37.27,,11.14,percent of total billed charges,37.27% of total billed charges,13.92,37.27,,11.14,percent of total billed charges,37.27% of total billed charges,13.92,37.27,,11.14,percent of total billed charges,37.27% 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,14.94,40,,11.95,percent of total billed charges,40% of total billed charges,13.92,29.88,
POLYCILLIN N IM/IV:1,6400014,CDM,250,RC,,,Outpatient,,,19.2,15.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.36,80,,12.29,percent of total billed charges,80% of total billed charges,7.16,37.27,,5.73,percent of total billed charges,37.27% of total billed charges,7.16,37.27,,5.73,percent of total billed charges,37.27% of total billed charges,7.16,37.27,,5.73,percent of total billed charges,37.27% 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,7.68,40,,6.14,percent of total billed charges,40% of total billed charges,7.16,15.36,
POLYCILLIN N IM?IV:2,6400014,CDM,250,RC,,,Outpatient,,,13.75,11.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11,80,,8.8,percent of total billed charges,80% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% 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,5.5,40,,4.4,percent of total billed charges,40% of total billed charges,5.12,11,
ACETAMINOPHEN SUPP.,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
ANUSOL HC CREAM,6400014,CDM,250,RC,,,Outpatient,,,51.9,41.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.52,80,,33.22,percent of total billed charges,80% of total billed charges,19.34,37.27,,15.47,percent of total billed charges,37.27% of total billed charges,19.34,37.27,,15.47,percent of total billed charges,37.27% of total billed charges,19.34,37.27,,15.47,percent of total billed charges,37.27% 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,20.76,40,,16.61,percent of total billed charges,40% of total billed charges,19.34,41.52,
ANUSOL SUPP,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
ANUSOL HC SUPP,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
IMIPRAMINE HCL TAB 5,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
CORTENEMA,6400014,CDM,250,RC,,,Outpatient,,,43.1,34.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.48,80,,27.58,percent of total billed charges,80% of total billed charges,16.06,37.27,,12.85,percent of total billed charges,37.27% of total billed charges,16.06,37.27,,12.85,percent of total billed charges,37.27% of total billed charges,16.06,37.27,,12.85,percent of total billed charges,37.27% 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,17.24,40,,13.79,percent of total billed charges,40% of total billed charges,16.06,34.48,
BISACODYL SUPP,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
GLYCERIN SUPP,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
KAYEXLATE AND SORBIT,6400014,CDM,250,RC,,,Outpatient,,,16.85,13.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.48,80,,10.78,percent of total billed charges,80% of total billed charges,6.28,37.27,,5.02,percent of total billed charges,37.27% of total billed charges,6.28,37.27,,5.02,percent of total billed charges,37.27% of total billed charges,6.28,37.27,,5.02,percent of total billed charges,37.27% 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,6.74,40,,5.39,percent of total billed charges,40% of total billed charges,6.28,13.48,
MONISTAT-7 VAG CREAM,6400014,CDM,250,RC,,,Outpatient,,,39.1,31.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.28,80,,25.02,percent of total billed charges,80% of total billed charges,14.57,37.27,,11.66,percent of total billed charges,37.27% of total billed charges,14.57,37.27,,11.66,percent of total billed charges,37.27% of total billed charges,14.57,37.27,,11.66,percent of total billed charges,37.27% 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,15.64,40,,12.51,percent of total billed charges,40% of total billed charges,14.57,31.28,
PHENERGAN 12.4MG SUP,6400014,CDM,250,RC,,,Outpatient,,,60.35,48.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.28,80,,38.62,percent of total billed charges,80% of total billed charges,22.49,37.27,,17.99,percent of total billed charges,37.27% of total billed charges,22.49,37.27,,17.99,percent of total billed charges,37.27% of total billed charges,22.49,37.27,,17.99,percent of total billed charges,37.27% 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,24.14,40,,19.31,percent of total billed charges,40% of total billed charges,22.49,48.28,
PHENERGAN 25MG SUPP,6400014,CDM,250,RC,,,Outpatient,,,60.35,48.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.28,80,,38.62,percent of total billed charges,80% of total billed charges,22.49,37.27,,17.99,percent of total billed charges,37.27% of total billed charges,22.49,37.27,,17.99,percent of total billed charges,37.27% of total billed charges,22.49,37.27,,17.99,percent of total billed charges,37.27% 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,24.14,40,,19.31,percent of total billed charges,40% of total billed charges,22.49,48.28,
PHENERGAN 50MG SUPP,6400014,CDM,250,RC,,,Outpatient,,,21.2,16.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.96,80,,13.57,percent of total billed charges,80% of total billed charges,7.9,37.27,,6.32,percent of total billed charges,37.27% of total billed charges,7.9,37.27,,6.32,percent of total billed charges,37.27% of total billed charges,7.9,37.27,,6.32,percent of total billed charges,37.27% 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,8.48,40,,6.78,percent of total billed charges,40% of total billed charges,7.9,16.96,
PREMARIN VAG CREAM,6400014,CDM,250,RC,,,Outpatient,,,2226.4,1781.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1781.12,80,,1424.9,percent of total billed charges,80% of total billed charges,829.78,37.27,,663.82,percent of total billed charges,37.27% of total billed charges,829.78,37.27,,663.82,percent of total billed charges,37.27% of total billed charges,829.78,37.27,,663.82,percent of total billed charges,37.27% 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,890.56,40,,712.45,percent of total billed charges,40% of total billed charges,829.78,1781.12,
PROCTOFOAM HC,6400014,CDM,250,RC,,,Outpatient,,,437,349.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,349.6,80,,279.68,percent of total billed charges,80% of total billed charges,162.87,37.27,,130.3,percent of total billed charges,37.27% of total billed charges,162.87,37.27,,130.3,percent of total billed charges,37.27% of total billed charges,162.87,37.27,,130.3,percent of total billed charges,37.27% 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,174.8,40,,139.84,percent of total billed charges,40% of total billed charges,162.87,349.6,
DURAGESIC 50MCG/HR P,6400014,CDM,250,RC,,,Outpatient,,,293.2,234.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.56,80,,187.65,percent of total billed charges,80% of total billed charges,109.28,37.27,,87.42,percent of total billed charges,37.27% of total billed charges,109.28,37.27,,87.42,percent of total billed charges,37.27% of total billed charges,109.28,37.27,,87.42,percent of total billed charges,37.27% 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,117.28,40,,93.82,percent of total billed charges,40% of total billed charges,109.28,234.56,
ISMO 20 MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.05,2.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.44,80,,1.95,percent of total billed charges,80% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% 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,1.22,40,,0.98,percent of total billed charges,40% of total billed charges,1.14,2.44,
TIGAN SUPP 100MG,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
TIGAN SUPP 200MG,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
THROMBIN TOPICAL,6400014,CDM,250,RC,,,Outpatient,,,1136.85,909.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,909.48,80,,727.58,percent of total billed charges,80% of total billed charges,423.7,37.27,,338.96,percent of total billed charges,37.27% of total billed charges,423.7,37.27,,338.96,percent of total billed charges,37.27% of total billed charges,423.7,37.27,,338.96,percent of total billed charges,37.27% 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,454.74,40,,363.79,percent of total billed charges,40% of total billed charges,423.7,909.48,
MONOPRIL 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,6.9,5.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.52,80,,4.42,percent of total billed charges,80% of total billed charges,2.57,37.27,,2.06,percent of total billed charges,37.27% of total billed charges,2.57,37.27,,2.06,percent of total billed charges,37.27% of total billed charges,2.57,37.27,,2.06,percent of total billed charges,37.27% 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,2.76,40,,2.21,percent of total billed charges,40% of total billed charges,2.57,5.52,
ALBUTEIN 25% 50ML,6400014,CDM,250,RC,,,Outpatient,,,368.3,294.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.64,80,,235.71,percent of total billed charges,80% of total billed charges,137.27,37.27,,109.82,percent of total billed charges,37.27% of total billed charges,137.27,37.27,,109.82,percent of total billed charges,37.27% of total billed charges,137.27,37.27,,109.82,percent of total billed charges,37.27% 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,147.32,40,,117.86,percent of total billed charges,40% of total billed charges,137.27,294.64,
ALBUTEIN 25% 100ML,6400014,CDM,250,RC,,,Outpatient,,,613.8,491.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,491.04,80,,392.83,percent of total billed charges,80% of total billed charges,228.76,37.27,,183.01,percent of total billed charges,37.27% of total billed charges,228.76,37.27,,183.01,percent of total billed charges,37.27% of total billed charges,228.76,37.27,,183.01,percent of total billed charges,37.27% 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,245.52,40,,196.42,percent of total billed charges,40% of total billed charges,228.76,491.04,
AFRIN 0.05% 15ML SPR,6400014,CDM,250,RC,,,Outpatient,,,15.25,12.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.2,80,,9.76,percent of total billed charges,80% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% 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,6.1,40,,4.88,percent of total billed charges,40% of total billed charges,5.68,12.2,
AMMONIA INHALANT AMP,6400014,CDM,250,RC,,,Outpatient,,,8.7,6.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.96,80,,5.57,percent of total billed charges,80% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% 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,3.48,40,,2.78,percent of total billed charges,40% of total billed charges,3.24,6.96,
BECONASE,6400014,CDM,250,RC,,,Outpatient,,,551.85,441.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,441.48,80,,353.18,percent of total billed charges,80% of total billed charges,205.67,37.27,,164.54,percent of total billed charges,37.27% of total billed charges,205.67,37.27,,164.54,percent of total billed charges,37.27% of total billed charges,205.67,37.27,,164.54,percent of total billed charges,37.27% 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,220.74,40,,176.59,percent of total billed charges,40% of total billed charges,205.67,441.48,
DILOR 400MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,2.3,1.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.84,80,,1.47,percent of total billed charges,80% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% 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,0.92,40,,0.74,percent of total billed charges,40% of total billed charges,0.86,1.84,
CHLORASEPTIC SPRAY,6400014,CDM,250,RC,,,Outpatient,,,13.4,10.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.72,80,,8.58,percent of total billed charges,80% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% 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,5.36,40,,4.29,percent of total billed charges,40% of total billed charges,4.99,10.72,
CHLORASEPTIC,6400014,CDM,250,RC,,,Outpatient,,,13.4,10.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.72,80,,8.58,percent of total billed charges,80% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% 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,5.36,40,,4.29,percent of total billed charges,40% of total billed charges,4.99,10.72,
MUCOMYST 30ML 10%,6400014,CDM,250,RC,,,Outpatient,,,156.5,125.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.2,80,,100.16,percent of total billed charges,80% of total billed charges,58.33,37.27,,46.66,percent of total billed charges,37.27% of total billed charges,58.33,37.27,,46.66,percent of total billed charges,37.27% of total billed charges,58.33,37.27,,46.66,percent of total billed charges,37.27% 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,62.6,40,,50.08,percent of total billed charges,40% of total billed charges,58.33,125.2,
NEO-SYNEPHRINE 1/2%,6400014,CDM,250,RC,,,Outpatient,,,11.9,9.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.52,80,,7.62,percent of total billed charges,80% of total billed charges,4.44,37.27,,3.55,percent of total billed charges,37.27% of total billed charges,4.44,37.27,,3.55,percent of total billed charges,37.27% of total billed charges,4.44,37.27,,3.55,percent of total billed charges,37.27% 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,4.76,40,,3.81,percent of total billed charges,40% of total billed charges,4.44,9.52,
OCEAN NASAL MIST,6400014,CDM,250,RC,,,Outpatient,,,13.4,10.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.72,80,,8.58,percent of total billed charges,80% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% 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,5.36,40,,4.29,percent of total billed charges,40% of total billed charges,4.99,10.72,
VENTOLIN 90MCG INHAL,6400014,CDM,250,RC,,,Outpatient,,,58.28,46.62,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.62,80,,37.3,percent of total billed charges,80% of total billed charges,21.72,37.27,,17.38,percent of total billed charges,37.27% of total billed charges,21.72,37.27,,17.38,percent of total billed charges,37.27% of total billed charges,21.72,37.27,,17.38,percent of total billed charges,37.27% 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,23.31,40,,18.65,percent of total billed charges,40% of total billed charges,21.72,46.62,
AURALGAN 10CC,6400014,CDM,250,RC,,,Outpatient,,,61.1,48.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.88,80,,39.1,percent of total billed charges,80% of total billed charges,22.77,37.27,,18.22,percent of total billed charges,37.27% of total billed charges,22.77,37.27,,18.22,percent of total billed charges,37.27% of total billed charges,22.77,37.27,,18.22,percent of total billed charges,37.27% 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,24.44,40,,19.55,percent of total billed charges,40% of total billed charges,22.77,48.88,
CERUMENEX 6CC OTIC,6400014,CDM,250,RC,,,Outpatient,,,72.2,57.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.76,80,,46.21,percent of total billed charges,80% of total billed charges,26.91,37.27,,21.53,percent of total billed charges,37.27% of total billed charges,26.91,37.27,,21.53,percent of total billed charges,37.27% of total billed charges,26.91,37.27,,21.53,percent of total billed charges,37.27% 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,28.88,40,,23.1,percent of total billed charges,40% of total billed charges,26.91,57.76,
CORTISPORIN OTIC 10C,6400014,CDM,250,RC,,,Outpatient,,,308.55,246.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.84,80,,197.47,percent of total billed charges,80% of total billed charges,115,37.27,,92,percent of total billed charges,37.27% of total billed charges,115,37.27,,92,percent of total billed charges,37.27% of total billed charges,115,37.27,,92,percent of total billed charges,37.27% 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,123.42,40,,98.74,percent of total billed charges,40% of total billed charges,115,246.84,
CORTISPORIN OTIC 10C,6400014,CDM,250,RC,,,Outpatient,,,28.25,22.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.6,80,,18.08,percent of total billed charges,80% of total billed charges,10.53,37.27,,8.42,percent of total billed charges,37.27% of total billed charges,10.53,37.27,,8.42,percent of total billed charges,37.27% of total billed charges,10.53,37.27,,8.42,percent of total billed charges,37.27% 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,11.3,40,,9.04,percent of total billed charges,40% of total billed charges,10.53,22.6,
CELEBREX 100MG CAPSU,6400014,CDM,250,RC,,,Outpatient,,,40.95,32.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.76,80,,26.21,percent of total billed charges,80% of total billed charges,15.26,37.27,,12.21,percent of total billed charges,37.27% of total billed charges,15.26,37.27,,12.21,percent of total billed charges,37.27% of total billed charges,15.26,37.27,,12.21,percent of total billed charges,37.27% 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,16.38,40,,13.1,percent of total billed charges,40% of total billed charges,15.26,32.76,
TYMPAGESIC BOTTLE,6400014,CDM,250,RC,,,Outpatient,,,32,25.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% 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,12.8,40,,10.24,percent of total billed charges,40% of total billed charges,11.93,25.6,
ATROPINE SULFATE 1%,6400014,CDM,250,RC,,,Outpatient,,,71.65,57.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.32,80,,45.86,percent of total billed charges,80% of total billed charges,26.7,37.27,,21.36,percent of total billed charges,37.27% of total billed charges,26.7,37.27,,21.36,percent of total billed charges,37.27% of total billed charges,26.7,37.27,,21.36,percent of total billed charges,37.27% 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,28.66,40,,22.93,percent of total billed charges,40% of total billed charges,26.7,57.32,
BSS 15ML,6400014,CDM,250,RC,,,Outpatient,,,49.75,39.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.8,80,,31.84,percent of total billed charges,80% of total billed charges,18.54,37.27,,14.83,percent of total billed charges,37.27% of total billed charges,18.54,37.27,,14.83,percent of total billed charges,37.27% of total billed charges,18.54,37.27,,14.83,percent of total billed charges,37.27% 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,19.9,40,,15.92,percent of total billed charges,40% of total billed charges,18.54,39.8,
CORTISPORIN OPHTH OI,6400014,CDM,250,RC,,,Outpatient,,,202.25,161.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.8,80,,129.44,percent of total billed charges,80% of total billed charges,75.38,37.27,,60.3,percent of total billed charges,37.27% of total billed charges,75.38,37.27,,60.3,percent of total billed charges,37.27% of total billed charges,75.38,37.27,,60.3,percent of total billed charges,37.27% 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,80.9,40,,64.72,percent of total billed charges,40% of total billed charges,75.38,161.8,
CORTISPORIN OPHTH SU,6400014,CDM,250,RC,,,Outpatient,,,202,161.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,161.6,80,,129.28,percent of total billed charges,80% of total billed charges,75.29,37.27,,60.23,percent of total billed charges,37.27% of total billed charges,75.29,37.27,,60.23,percent of total billed charges,37.27% of total billed charges,75.29,37.27,,60.23,percent of total billed charges,37.27% 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,80.8,40,,64.64,percent of total billed charges,40% of total billed charges,75.29,161.6,
CYCLOGYL 2ML,6400014,CDM,250,RC,,,Outpatient,,,27.45,21.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.96,80,,17.57,percent of total billed charges,80% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% 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,10.98,40,,8.78,percent of total billed charges,40% of total billed charges,10.23,21.96,
GENTACIDIN OPTH OINT,6400014,CDM,250,RC,,,Outpatient,,,68.1,54.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.48,80,,43.58,percent of total billed charges,80% of total billed charges,25.38,37.27,,20.3,percent of total billed charges,37.27% of total billed charges,25.38,37.27,,20.3,percent of total billed charges,37.27% of total billed charges,25.38,37.27,,20.3,percent of total billed charges,37.27% 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,27.24,40,,21.79,percent of total billed charges,40% of total billed charges,25.38,54.48,
GENOPTIC OPHTHALMIC,6400014,CDM,250,RC,,,Outpatient,,,146.1,116.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.88,80,,93.5,percent of total billed charges,80% of total billed charges,54.45,37.27,,43.56,percent of total billed charges,37.27% of total billed charges,54.45,37.27,,43.56,percent of total billed charges,37.27% of total billed charges,54.45,37.27,,43.56,percent of total billed charges,37.27% 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,58.44,40,,46.75,percent of total billed charges,40% of total billed charges,54.45,116.88,
ISOPTO ATROPINE 1% 5,6400014,CDM,250,RC,,,Outpatient,,,34.65,27.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,80,,22.18,percent of total billed charges,80% of total billed charges,12.91,37.27,,10.33,percent of total billed charges,37.27% of total billed charges,12.91,37.27,,10.33,percent of total billed charges,37.27% of total billed charges,12.91,37.27,,10.33,percent of total billed charges,37.27% 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,13.86,40,,11.09,percent of total billed charges,40% of total billed charges,12.91,27.72,
ISOPTO-HOMATROPINE 2,6400014,CDM,250,RC,,,Outpatient,,,136.25,109.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109,80,,87.2,percent of total billed charges,80% of total billed charges,50.78,37.27,,40.62,percent of total billed charges,37.27% of total billed charges,50.78,37.27,,40.62,percent of total billed charges,37.27% of total billed charges,50.78,37.27,,40.62,percent of total billed charges,37.27% 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,54.5,40,,43.6,percent of total billed charges,40% of total billed charges,50.78,109,
NAPHCON-A 15CC,6400014,CDM,250,RC,,,Outpatient,,,16.5,13.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,80,,10.56,percent of total billed charges,80% of total billed charges,6.15,37.27,,4.92,percent of total billed charges,37.27% of total billed charges,6.15,37.27,,4.92,percent of total billed charges,37.27% of total billed charges,6.15,37.27,,4.92,percent of total billed charges,37.27% 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,6.6,40,,5.28,percent of total billed charges,40% of total billed charges,6.15,13.2,
NEO-DECADRON OINT OP,6400014,CDM,250,RC,,,Outpatient,,,17.7,14.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.16,80,,11.33,percent of total billed charges,80% of total billed charges,6.6,37.27,,5.28,percent of total billed charges,37.27% of total billed charges,6.6,37.27,,5.28,percent of total billed charges,37.27% of total billed charges,6.6,37.27,,5.28,percent of total billed charges,37.27% 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,7.08,40,,5.66,percent of total billed charges,40% of total billed charges,6.6,14.16,
VASERETIC 10/25,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
NEOSPORIN OPTH SOLN,6400014,CDM,250,RC,,,Outpatient,,,192.65,154.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.12,80,,123.3,percent of total billed charges,80% of total billed charges,71.8,37.27,,57.44,percent of total billed charges,37.27% of total billed charges,71.8,37.27,,57.44,percent of total billed charges,37.27% of total billed charges,71.8,37.27,,57.44,percent of total billed charges,37.27% 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,77.06,40,,61.65,percent of total billed charges,40% of total billed charges,71.8,154.12,
ALCAINE OPTH SOLN,6400014,CDM,250,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
PONTOCAINE OINT OPTH,6400014,CDM,250,RC,,,Outpatient,,,26.55,21.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.24,80,,16.99,percent of total billed charges,80% of total billed charges,9.9,37.27,,7.92,percent of total billed charges,37.27% of total billed charges,9.9,37.27,,7.92,percent of total billed charges,37.27% of total billed charges,9.9,37.27,,7.92,percent of total billed charges,37.27% 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,10.62,40,,8.5,percent of total billed charges,40% of total billed charges,9.9,21.24,
PONTOCAINE 0.5% SOL,6400014,CDM,250,RC,,,Outpatient,,,34.6,27.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.68,80,,22.14,percent of total billed charges,80% of total billed charges,12.9,37.27,,10.32,percent of total billed charges,37.27% of total billed charges,12.9,37.27,,10.32,percent of total billed charges,37.27% of total billed charges,12.9,37.27,,10.32,percent of total billed charges,37.27% 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,13.84,40,,11.07,percent of total billed charges,40% of total billed charges,12.9,27.68,
PRED. FORTE 1% 5ML,6400014,CDM,250,RC,,,Outpatient,,,45,36.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% 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,18,40,,14.4,percent of total billed charges,40% of total billed charges,16.77,36,
SODIUM SULAMYD OINT,6400014,CDM,250,RC,,,Outpatient,,,36.95,29.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.56,80,,23.65,percent of total billed charges,80% of total billed charges,13.77,37.27,,11.02,percent of total billed charges,37.27% of total billed charges,13.77,37.27,,11.02,percent of total billed charges,37.27% of total billed charges,13.77,37.27,,11.02,percent of total billed charges,37.27% 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,14.78,40,,11.82,percent of total billed charges,40% of total billed charges,13.77,29.56,
TIMOLOL 0.25% SOL,6400014,CDM,250,RC,,,Outpatient,,,51.15,40.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.92,80,,32.74,percent of total billed charges,80% of total billed charges,19.06,37.27,,15.25,percent of total billed charges,37.27% of total billed charges,19.06,37.27,,15.25,percent of total billed charges,37.27% of total billed charges,19.06,37.27,,15.25,percent of total billed charges,37.27% 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,20.46,40,,16.37,percent of total billed charges,40% of total billed charges,19.06,40.92,
VASOCON A SOL 15ML,6400014,CDM,250,RC,,,Outpatient,,,53.2,42.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.56,80,,34.05,percent of total billed charges,80% of total billed charges,19.83,37.27,,15.86,percent of total billed charges,37.27% of total billed charges,19.83,37.27,,15.86,percent of total billed charges,37.27% of total billed charges,19.83,37.27,,15.86,percent of total billed charges,37.27% 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,21.28,40,,17.02,percent of total billed charges,40% of total billed charges,19.83,42.56,
VISINE,6400014,CDM,250,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
A & D OINTMENT,6400014,CDM,250,RC,,,Outpatient,,,8.1,6.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.48,80,,5.18,percent of total billed charges,80% of total billed charges,3.02,37.27,,2.42,percent of total billed charges,37.27% of total billed charges,3.02,37.27,,2.42,percent of total billed charges,37.27% of total billed charges,3.02,37.27,,2.42,percent of total billed charges,37.27% 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,3.24,40,,2.59,percent of total billed charges,40% of total billed charges,3.02,6.48,
ARISTOCORT-R,6400014,CDM,250,RC,,,Outpatient,,,33.2,26.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,80,,21.25,percent of total billed charges,80% of total billed charges,12.37,37.27,,9.9,percent of total billed charges,37.27% of total billed charges,12.37,37.27,,9.9,percent of total billed charges,37.27% of total billed charges,12.37,37.27,,9.9,percent of total billed charges,37.27% 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,13.28,40,,10.62,percent of total billed charges,40% of total billed charges,12.37,26.56,
AVEENO COLLOIDAL OAT,6400014,CDM,250,RC,,,Outpatient,,,24.95,19.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.96,80,,15.97,percent of total billed charges,80% of total billed charges,9.3,37.27,,7.44,percent of total billed charges,37.27% of total billed charges,9.3,37.27,,7.44,percent of total billed charges,37.27% of total billed charges,9.3,37.27,,7.44,percent of total billed charges,37.27% 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,9.98,40,,7.98,percent of total billed charges,40% of total billed charges,9.3,19.96,
AVITENE 1 GM,6400014,CDM,250,RC,,,Outpatient,,,369.85,295.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,295.88,80,,236.7,percent of total billed charges,80% of total billed charges,137.84,37.27,,110.27,percent of total billed charges,37.27% of total billed charges,137.84,37.27,,110.27,percent of total billed charges,37.27% of total billed charges,137.84,37.27,,110.27,percent of total billed charges,37.27% 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,147.94,40,,118.35,percent of total billed charges,40% of total billed charges,137.84,295.88,
BACITRACIN,6400014,CDM,250,RC,,,Outpatient,,,27.45,21.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.96,80,,17.57,percent of total billed charges,80% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% 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,10.98,40,,8.78,percent of total billed charges,40% of total billed charges,10.23,21.96,
BENICAR 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,32.95,26.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.36,80,,21.09,percent of total billed charges,80% of total billed charges,12.28,37.27,,9.82,percent of total billed charges,37.27% of total billed charges,12.28,37.27,,9.82,percent of total billed charges,37.27% of total billed charges,12.28,37.27,,9.82,percent of total billed charges,37.27% 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,13.18,40,,10.54,percent of total billed charges,40% of total billed charges,12.28,26.36,
BETADINE SOLN 8OZ,6400014,CDM,250,RC,,,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% 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,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,10.06,21.6,
CALADRYL LOTION,6400014,CDM,250,RC,,,Outpatient,,,15.25,12.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.2,80,,9.76,percent of total billed charges,80% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% 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,6.1,40,,4.88,percent of total billed charges,40% of total billed charges,5.68,12.2,
CHAP STICK,6400014,CDM,250,RC,,,Outpatient,,,3.25,2.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.6,80,,2.08,percent of total billed charges,80% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% 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,1.3,40,,1.04,percent of total billed charges,40% of total billed charges,1.21,2.6,
DERMOPLAST SPRAY,5880901,CDM,637,RC,,,Outpatient,,,16.75,13.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.4,80,,10.72,percent of total billed charges,80% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% 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,6.7,40,,5.36,percent of total billed charges,40% of total billed charges,6.24,13.4,
DESITIN OINTMENT 28G,6400014,CDM,250,RC,,,Outpatient,,,11.9,9.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.52,80,,7.62,percent of total billed charges,80% of total billed charges,4.44,37.27,,3.55,percent of total billed charges,37.27% of total billed charges,4.44,37.27,,3.55,percent of total billed charges,37.27% of total billed charges,4.44,37.27,,3.55,percent of total billed charges,37.27% 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,4.76,40,,3.81,percent of total billed charges,40% of total billed charges,4.44,9.52,
EPSOM SALT 1LB,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
GELFOAM SPONGE 12-7M,5880901,CDM,637,RC,,,Outpatient,,,31,24.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% 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,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,11.55,24.8,
GRANULEX SPRAY,6400014,CDM,250,RC,,,Outpatient,,,47,37.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% 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,18.8,40,,15.04,percent of total billed charges,40% of total billed charges,17.52,37.6,
JOHNSON'S BABY POWD.,5828504,CDM,990,RC,,,Outpatient,,,8.15,6.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
KENALOG IN ORABASE 5,6065130,CDM,636,RC,J3301,HCPCS,Outpatient,,,31.2,24.96,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.96,80,,19.97,percent of total billed charges,80% of total billed charges,11.63,37.27,,9.3,percent of total billed charges,37.27% of total billed charges,11.63,37.27,,9.3,percent of total billed charges,37.27% of total billed charges,11.63,37.27,,9.3,percent of total billed charges,37.27% 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,12.48,40,,9.98,percent of total billed charges,40% of total billed charges,11.63,24.96,
LOTRISONE CREAM 15GM,6400014,CDM,250,RC,,,Outpatient,,,95.55,76.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.44,80,,61.15,percent of total billed charges,80% of total billed charges,35.61,37.27,,28.49,percent of total billed charges,37.27% of total billed charges,35.61,37.27,,28.49,percent of total billed charges,37.27% of total billed charges,35.61,37.27,,28.49,percent of total billed charges,37.27% 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,38.22,40,,30.58,percent of total billed charges,40% of total billed charges,35.61,76.44,
MYCO-TRICET II CREAM,6400014,CDM,250,RC,,,Outpatient,,,325.75,260.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260.6,80,,208.48,percent of total billed charges,80% of total billed charges,121.41,37.27,,97.13,percent of total billed charges,37.27% of total billed charges,121.41,37.27,,97.13,percent of total billed charges,37.27% of total billed charges,121.41,37.27,,97.13,percent of total billed charges,37.27% 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,130.3,40,,104.24,percent of total billed charges,40% of total billed charges,121.41,260.6,
MYCO-TRICET II OINT,6400014,CDM,250,RC,,,Outpatient,,,325.75,260.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260.6,80,,208.48,percent of total billed charges,80% of total billed charges,121.41,37.27,,97.13,percent of total billed charges,37.27% of total billed charges,121.41,37.27,,97.13,percent of total billed charges,37.27% of total billed charges,121.41,37.27,,97.13,percent of total billed charges,37.27% 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,130.3,40,,104.24,percent of total billed charges,40% of total billed charges,121.41,260.6,
NYSTATIN CREAM,6400014,CDM,250,RC,,,Outpatient,,,33.65,26.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.92,80,,21.54,percent of total billed charges,80% of total billed charges,12.54,37.27,,10.03,percent of total billed charges,37.27% of total billed charges,12.54,37.27,,10.03,percent of total billed charges,37.27% of total billed charges,12.54,37.27,,10.03,percent of total billed charges,37.27% 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,13.46,40,,10.77,percent of total billed charges,40% of total billed charges,12.54,26.92,
NYSTATIN OINT,6400014,CDM,250,RC,,,Outpatient,,,33.65,26.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.92,80,,21.54,percent of total billed charges,80% of total billed charges,12.54,37.27,,10.03,percent of total billed charges,37.27% of total billed charges,12.54,37.27,,10.03,percent of total billed charges,37.27% of total billed charges,12.54,37.27,,10.03,percent of total billed charges,37.27% 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,13.46,40,,10.77,percent of total billed charges,40% of total billed charges,12.54,26.92,
MYLOFLEX CREAM 2OZ,6400014,CDM,250,RC,,,Outpatient,,,16.05,12.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.84,80,,10.27,percent of total billed charges,80% of total billed charges,5.98,37.27,,4.78,percent of total billed charges,37.27% of total billed charges,5.98,37.27,,4.78,percent of total billed charges,37.27% of total billed charges,5.98,37.27,,4.78,percent of total billed charges,37.27% 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,6.42,40,,5.14,percent of total billed charges,40% of total billed charges,5.98,12.84,
NEOSPORIN FOIL PACKS,6400014,CDM,250,RC,,,Outpatient,,,3.25,2.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.6,80,,2.08,percent of total billed charges,80% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% 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,1.3,40,,1.04,percent of total billed charges,40% of total billed charges,1.21,2.6,
NEOSPORIN OINT,6400014,CDM,250,RC,,,Outpatient,,,11.1,8.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.88,80,,7.1,percent of total billed charges,80% of total billed charges,4.14,37.27,,3.31,percent of total billed charges,37.27% of total billed charges,4.14,37.27,,3.31,percent of total billed charges,37.27% of total billed charges,4.14,37.27,,3.31,percent of total billed charges,37.27% 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,4.44,40,,3.55,percent of total billed charges,40% of total billed charges,4.14,8.88,
PHISOHEX 5OZ,6400014,CDM,250,RC,,,Outpatient,,,50.35,40.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.28,80,,32.22,percent of total billed charges,80% of total billed charges,18.77,37.27,,15.02,percent of total billed charges,37.27% of total billed charges,18.77,37.27,,15.02,percent of total billed charges,37.27% of total billed charges,18.77,37.27,,15.02,percent of total billed charges,37.27% 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,20.14,40,,16.11,percent of total billed charges,40% of total billed charges,18.77,40.28,
PREPARATION H OINT,6400014,CDM,250,RC,,,Outpatient,,,17.25,13.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.8,80,,11.04,percent of total billed charges,80% of total billed charges,6.43,37.27,,5.14,percent of total billed charges,37.27% of total billed charges,6.43,37.27,,5.14,percent of total billed charges,37.27% of total billed charges,6.43,37.27,,5.14,percent of total billed charges,37.27% 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,6.9,40,,5.52,percent of total billed charges,40% of total billed charges,6.43,13.8,
SILVADENE CREAM 400G,6400014,CDM,250,RC,,,Outpatient,,,107.5,86.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86,80,,68.8,percent of total billed charges,80% of total billed charges,40.07,37.27,,32.06,percent of total billed charges,37.27% of total billed charges,40.07,37.27,,32.06,percent of total billed charges,37.27% of total billed charges,40.07,37.27,,32.06,percent of total billed charges,37.27% 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,43,40,,34.4,percent of total billed charges,40% of total billed charges,40.07,86,
STOMAHESIVE PASTE,6400014,CDM,250,RC,,,Outpatient,,,33.3,26.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.64,80,,21.31,percent of total billed charges,80% of total billed charges,12.41,37.27,,9.93,percent of total billed charges,37.27% of total billed charges,12.41,37.27,,9.93,percent of total billed charges,37.27% of total billed charges,12.41,37.27,,9.93,percent of total billed charges,37.27% 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,13.32,40,,10.66,percent of total billed charges,40% of total billed charges,12.41,26.64,
TRANSDERM-NITRO 5 PA,6400014,CDM,250,RC,,,Outpatient,,,5.35,4.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.28,80,,3.42,percent of total billed charges,80% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% 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,2.14,40,,1.71,percent of total billed charges,40% of total billed charges,1.99,4.28,
TUCKS PADS,6400014,CDM,250,RC,,,Outpatient,,,14.1,11.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.28,80,,9.02,percent of total billed charges,80% of total billed charges,5.26,37.27,,4.21,percent of total billed charges,37.27% of total billed charges,5.26,37.27,,4.21,percent of total billed charges,37.27% of total billed charges,5.26,37.27,,4.21,percent of total billed charges,37.27% 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,5.64,40,,4.51,percent of total billed charges,40% of total billed charges,5.26,11.28,
VICKS VAPORUB,6400014,CDM,250,RC,,,Outpatient,,,13.55,10.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.84,80,,8.67,percent of total billed charges,80% of total billed charges,5.05,37.27,,4.04,percent of total billed charges,37.27% of total billed charges,5.05,37.27,,4.04,percent of total billed charges,37.27% of total billed charges,5.05,37.27,,4.04,percent of total billed charges,37.27% 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,5.42,40,,4.34,percent of total billed charges,40% of total billed charges,5.05,10.84,
XYLOCAINE JELLY TUBE,6400014,CDM,250,RC,,,Outpatient,,,32.3,25.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.84,80,,20.67,percent of total billed charges,80% of total billed charges,12.04,37.27,,9.63,percent of total billed charges,37.27% of total billed charges,12.04,37.27,,9.63,percent of total billed charges,37.27% of total billed charges,12.04,37.27,,9.63,percent of total billed charges,37.27% 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,12.92,40,,10.34,percent of total billed charges,40% of total billed charges,12.04,25.84,
ZINC OXIDE OINT 30GM,6400014,CDM,250,RC,,,Outpatient,,,9.25,7.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.4,80,,5.92,percent of total billed charges,80% of total billed charges,3.45,37.27,,2.76,percent of total billed charges,37.27% of total billed charges,3.45,37.27,,2.76,percent of total billed charges,37.27% of total billed charges,3.45,37.27,,2.76,percent of total billed charges,37.27% 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,3.7,40,,2.96,percent of total billed charges,40% of total billed charges,3.45,7.4,
ZOVIRAX OINT 15GM TU,6400014,CDM,250,RC,,,Outpatient,,,162.43,129.94,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.94,80,,103.95,percent of total billed charges,80% of total billed charges,60.54,37.27,,48.43,percent of total billed charges,37.27% of total billed charges,60.54,37.27,,48.43,percent of total billed charges,37.27% of total billed charges,60.54,37.27,,48.43,percent of total billed charges,37.27% 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,64.97,40,,51.98,percent of total billed charges,40% of total billed charges,60.54,129.94,
ZOVIRAX OINT 3GM TUB,6400014,CDM,250,RC,,,Outpatient,,,42.5,34.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34,80,,27.2,percent of total billed charges,80% of total billed charges,15.84,37.27,,12.67,percent of total billed charges,37.27% of total billed charges,15.84,37.27,,12.67,percent of total billed charges,37.27% of total billed charges,15.84,37.27,,12.67,percent of total billed charges,37.27% 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,17,40,,13.6,percent of total billed charges,40% of total billed charges,15.84,34,
WELLBUTRIN 75MG TAB,6400014,CDM,250,RC,,,Outpatient,,,5.3,4.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.24,80,,3.39,percent of total billed charges,80% of total billed charges,1.98,37.27,,1.58,percent of total billed charges,37.27% of total billed charges,1.98,37.27,,1.58,percent of total billed charges,37.27% of total billed charges,1.98,37.27,,1.58,percent of total billed charges,37.27% 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,2.12,40,,1.7,percent of total billed charges,40% of total billed charges,1.98,4.24,
CEFZIL SUSP 125MG 50,6400014,CDM,250,RC,,,Outpatient,,,81.95,65.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.56,80,,52.45,percent of total billed charges,80% of total billed charges,30.54,37.27,,24.43,percent of total billed charges,37.27% of total billed charges,30.54,37.27,,24.43,percent of total billed charges,37.27% of total billed charges,30.54,37.27,,24.43,percent of total billed charges,37.27% 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,32.78,40,,26.22,percent of total billed charges,40% of total billed charges,30.54,65.56,
FERROUS GLUC,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
AMOXICILLIN 500MG CA,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
AMPICILLIN 500MG VIA,6065130,CDM,636,RC,J0290,HCPCS,Outpatient,,,38.95,31.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.16,80,,24.93,percent of total billed charges,80% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% 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,15.58,40,,12.46,percent of total billed charges,40% of total billed charges,14.52,31.16,
ALBUTEROL 90MCG INHA,6400014,CDM,250,RC,,,Outpatient,,,101.55,81.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.24,80,,64.99,percent of total billed charges,80% of total billed charges,37.85,37.27,,30.28,percent of total billed charges,37.27% of total billed charges,37.85,37.27,,30.28,percent of total billed charges,37.27% of total billed charges,37.85,37.27,,30.28,percent of total billed charges,37.27% 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,40.62,40,,32.5,percent of total billed charges,40% of total billed charges,37.85,81.24,
ALBUTEROL SULFATE 4M,6400014,CDM,250,RC,,,Outpatient,,,59.85,47.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.88,80,,38.3,percent of total billed charges,80% of total billed charges,22.31,37.27,,17.85,percent of total billed charges,37.27% of total billed charges,22.31,37.27,,17.85,percent of total billed charges,37.27% of total billed charges,22.31,37.27,,17.85,percent of total billed charges,37.27% 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,23.94,40,,19.15,percent of total billed charges,40% of total billed charges,22.31,47.88,
ALBUTEROL SYRUP 2MG/,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
ALLOPURINOL 300MG TA,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ALLOPURINOL 300MG TA,6400014,CDM,250,RC,,,Outpatient,,,3.2,2.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,80,,2.05,percent of total billed charges,80% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% 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,1.28,40,,1.02,percent of total billed charges,40% of total billed charges,1.19,2.56,
ALPRAZOLAM 1MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,3.55,2.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.84,80,,2.27,percent of total billed charges,80% of total billed charges,1.32,37.27,,1.06,percent of total billed charges,37.27% of total billed charges,1.32,37.27,,1.06,percent of total billed charges,37.27% of total billed charges,1.32,37.27,,1.06,percent of total billed charges,37.27% 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,1.42,40,,1.14,percent of total billed charges,40% of total billed charges,1.32,2.84,
AMARYL 2MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
AMIKACIN 500MG/2ML,6065130,CDM,636,RC,J0278,HCPCS,Outpatient,,,7.79,6.23,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.23,80,,4.98,percent of total billed charges,80% of total billed charges,2.9,37.27,,2.32,percent of total billed charges,37.27% of total billed charges,2.9,37.27,,2.32,percent of total billed charges,37.27% of total billed charges,2.9,37.27,,2.32,percent of total billed charges,37.27% 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,3.12,40,,2.5,percent of total billed charges,40% of total billed charges,2.9,6.23,
AMITRIPTYLINE 10MG T,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
AMPICILLIN 125MG VIA,6065130,CDM,636,RC,J0290,HCPCS,Outpatient,,,13.75,11.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11,80,,8.8,percent of total billed charges,80% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% 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,5.5,40,,4.4,percent of total billed charges,40% of total billed charges,5.12,11,
AMPICILLIN 250MG VIA,6065130,CDM,636,RC,J0290,HCPCS,Outpatient,,,38.95,31.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.16,80,,24.93,percent of total billed charges,80% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% 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,15.58,40,,12.46,percent of total billed charges,40% of total billed charges,14.52,31.16,
ANTACID DS LIQUID,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
ANTACID/SIMETHICONE,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
GLUCOTROL XL 10MG TA,6400014,CDM,250,RC,,,Outpatient,,,2.7,2.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,80,,1.73,percent of total billed charges,80% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% 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,1.08,40,,0.86,percent of total billed charges,40% of total billed charges,1.01,2.16,
LOPERAMIDE 2MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
LOPERAMIDE LIQUID 1M,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
LITHIUM CITRATE LIGU,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
AMPICILLIN 1GM VIAL,6065130,CDM,636,RC,J0290,HCPCS,Outpatient,,,19.48,15.58,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.58,80,,12.46,percent of total billed charges,80% of total billed charges,7.26,37.27,,5.81,percent of total billed charges,37.27% of total billed charges,7.26,37.27,,5.81,percent of total billed charges,37.27% of total billed charges,7.26,37.27,,5.81,percent of total billed charges,37.27% 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,7.79,40,,6.23,percent of total billed charges,40% of total billed charges,7.26,15.58,
AREDIA 90MG VIAL,6065130,CDM,636,RC,J2430,HCPCS,Outpatient,,,728.82,583.06,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,583.06,80,,466.45,percent of total billed charges,80% of total billed charges,271.63,37.27,,217.3,percent of total billed charges,37.27% of total billed charges,271.63,37.27,,217.3,percent of total billed charges,37.27% of total billed charges,271.63,37.27,,217.3,percent of total billed charges,37.27% 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,291.53,40,,233.22,percent of total billed charges,40% of total billed charges,271.63,583.06,
ARICEPT 5MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,32.05,25.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.64,80,,20.51,percent of total billed charges,80% of total billed charges,11.95,37.27,,9.56,percent of total billed charges,37.27% of total billed charges,11.95,37.27,,9.56,percent of total billed charges,37.27% of total billed charges,11.95,37.27,,9.56,percent of total billed charges,37.27% 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,12.82,40,,10.26,percent of total billed charges,40% of total billed charges,11.95,25.64,
ARMOUR THYROID 65MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ARTIFICIAL TEARS EYE,6400014,CDM,250,RC,,,Outpatient,,,30.6,24.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.48,80,,19.58,percent of total billed charges,80% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% 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,12.24,40,,9.79,percent of total billed charges,40% of total billed charges,11.4,24.48,
ASPIRIN W/ANTACID A/,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ATENOLOL 25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.7,2.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,80,,1.73,percent of total billed charges,80% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% 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,1.08,40,,0.86,percent of total billed charges,40% of total billed charges,1.01,2.16,
ATENOLOL 25MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ATENOLOL 50MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,2.85,2.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,80,,1.82,percent of total billed charges,80% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% 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,1.14,40,,0.91,percent of total billed charges,40% of total billed charges,1.06,2.28,
ATUSS MS SYRUP (POLY,6400014,CDM,250,RC,,,Outpatient,,,7.71,6.17,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.17,80,,4.94,percent of total billed charges,80% of total billed charges,2.87,37.27,,2.3,percent of total billed charges,37.27% of total billed charges,2.87,37.27,,2.3,percent of total billed charges,37.27% of total billed charges,2.87,37.27,,2.3,percent of total billed charges,37.27% 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,3.08,40,,2.46,percent of total billed charges,40% of total billed charges,2.87,6.17,
AVAPRO 150MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,5.65,4.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.52,80,,3.62,percent of total billed charges,80% of total billed charges,2.11,37.27,,1.69,percent of total billed charges,37.27% of total billed charges,2.11,37.27,,1.69,percent of total billed charges,37.27% of total billed charges,2.11,37.27,,1.69,percent of total billed charges,37.27% 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,2.26,40,,1.81,percent of total billed charges,40% of total billed charges,2.11,4.52,
AXOCET CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
AZATHIOPRINE 50MG TA,6400014,CDM,250,RC,,,Outpatient,,,7.95,6.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.36,80,,5.09,percent of total billed charges,80% of total billed charges,2.96,37.27,,2.37,percent of total billed charges,37.27% of total billed charges,2.96,37.27,,2.37,percent of total billed charges,37.27% of total billed charges,2.96,37.27,,2.37,percent of total billed charges,37.27% 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,3.18,40,,2.54,percent of total billed charges,40% of total billed charges,2.96,6.36,
AMILORIDE HCL/HCTZ 5,6400014,CDM,250,RC,,,Outpatient,,,3.9,3.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.12,80,,2.5,percent of total billed charges,80% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% 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,1.56,40,,1.25,percent of total billed charges,40% of total billed charges,1.45,3.12,
AMANTADINE 50MG/5ML,6400014,CDM,250,RC,,,Outpatient,,,15.7,12.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,80,,10.05,percent of total billed charges,80% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% 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,6.28,40,,5.02,percent of total billed charges,40% of total billed charges,5.85,12.56,
AMANTADIEN 100MG CAP,6400014,CDM,250,RC,,,Outpatient,,,9.05,7.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.24,80,,5.79,percent of total billed charges,80% of total billed charges,3.37,37.27,,2.7,percent of total billed charges,37.27% of total billed charges,3.37,37.27,,2.7,percent of total billed charges,37.27% of total billed charges,3.37,37.27,,2.7,percent of total billed charges,37.27% 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,3.62,40,,2.9,percent of total billed charges,40% of total billed charges,3.37,7.24,
AMITRIP/PERPHEN 10-2,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ACYCLOVIR SOD 500MG,6065130,CDM,636,RC,J0133,HCPCS,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ZYPREXA 5MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,50.05,40.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.04,80,,32.03,percent of total billed charges,80% of total billed charges,18.65,37.27,,14.92,percent of total billed charges,37.27% of total billed charges,18.65,37.27,,14.92,percent of total billed charges,37.27% of total billed charges,18.65,37.27,,14.92,percent of total billed charges,37.27% 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,20.02,40,,16.02,percent of total billed charges,40% of total billed charges,18.65,40.04,
ZOSYN 4.5 GM VIAL,6065130,CDM,636,RC,J2543,HCPCS,Outpatient,,,98.9,79.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.12,80,,63.3,percent of total billed charges,80% of total billed charges,36.86,37.27,,29.49,percent of total billed charges,37.27% of total billed charges,36.86,37.27,,29.49,percent of total billed charges,37.27% of total billed charges,36.86,37.27,,29.49,percent of total billed charges,37.27% 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,39.56,40,,31.65,percent of total billed charges,40% of total billed charges,36.86,79.12,
ZOSYN 3.375 GM VIAL,6065130,CDM,636,RC,J2543,HCPCS,Outpatient,,,78.1,62.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.48,80,,49.98,percent of total billed charges,80% of total billed charges,29.11,37.27,,23.29,percent of total billed charges,37.27% of total billed charges,29.11,37.27,,23.29,percent of total billed charges,37.27% of total billed charges,29.11,37.27,,23.29,percent of total billed charges,37.27% 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,31.24,40,,24.99,percent of total billed charges,40% of total billed charges,29.11,62.48,
ZOLOFT 25MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,9.95,7.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.96,80,,6.37,percent of total billed charges,80% of total billed charges,3.71,37.27,,2.97,percent of total billed charges,37.27% of total billed charges,3.71,37.27,,2.97,percent of total billed charges,37.27% of total billed charges,3.71,37.27,,2.97,percent of total billed charges,37.27% 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,3.98,40,,3.18,percent of total billed charges,40% of total billed charges,3.71,7.96,
ZOSYN 2.25 GM VIAL,6065130,CDM,636,RC,J2543,HCPCS,Outpatient,,,52.05,41.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.64,80,,33.31,percent of total billed charges,80% of total billed charges,19.4,37.27,,15.52,percent of total billed charges,37.27% of total billed charges,19.4,37.27,,15.52,percent of total billed charges,37.27% of total billed charges,19.4,37.27,,15.52,percent of total billed charges,37.27% 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,20.82,40,,16.66,percent of total billed charges,40% of total billed charges,19.4,41.64,
ZESTRIL 20MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,2.05,1.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.64,80,,1.31,percent of total billed charges,80% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% 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,0.82,40,,0.66,percent of total billed charges,40% of total billed charges,0.76,1.64,
ZINC SULFATE 220MG C,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ZITHROMAX 250MG TAB,6400014,CDM,250,RC,,,Outpatient,,,36.5,29.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,80,,23.36,percent of total billed charges,80% of total billed charges,13.6,37.27,,10.88,percent of total billed charges,37.27% of total billed charges,13.6,37.27,,10.88,percent of total billed charges,37.27% of total billed charges,13.6,37.27,,10.88,percent of total billed charges,37.27% 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,14.6,40,,11.68,percent of total billed charges,40% of total billed charges,13.6,29.2,
BUMETANIDE 0.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
BUMETANIDE 1MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,8.3,6.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.64,80,,5.31,percent of total billed charges,80% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% 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,3.32,40,,2.66,percent of total billed charges,40% of total billed charges,3.09,6.64,
BUMETANIDE 0.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.7,2.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.96,80,,2.37,percent of total billed charges,80% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% 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,1.48,40,,1.18,percent of total billed charges,40% of total billed charges,1.38,2.96,
BIAXIN 500MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,10.2,8.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.16,80,,6.53,percent of total billed charges,80% of total billed charges,3.8,37.27,,3.04,percent of total billed charges,37.27% of total billed charges,3.8,37.27,,3.04,percent of total billed charges,37.27% of total billed charges,3.8,37.27,,3.04,percent of total billed charges,37.27% 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,4.08,40,,3.26,percent of total billed charges,40% of total billed charges,3.8,8.16,
BETASEPT 4% SURGICAL,5880901,CDM,637,RC,,,Outpatient,,,15.57,12.46,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.46,80,,9.97,percent of total billed charges,80% of total billed charges,5.8,37.27,,4.64,percent of total billed charges,37.27% of total billed charges,5.8,37.27,,4.64,percent of total billed charges,37.27% of total billed charges,5.8,37.27,,4.64,percent of total billed charges,37.27% 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,6.23,40,,4.98,percent of total billed charges,40% of total billed charges,5.8,12.46,
BETADINE DOUCHE 30ML,6400014,CDM,250,RC,,,Outpatient,,,30.68,24.54,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.54,80,,19.63,percent of total billed charges,80% of total billed charges,11.43,37.27,,9.14,percent of total billed charges,37.27% of total billed charges,11.43,37.27,,9.14,percent of total billed charges,37.27% of total billed charges,11.43,37.27,,9.14,percent of total billed charges,37.27% 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,12.27,40,,9.82,percent of total billed charges,40% of total billed charges,11.43,24.54,
BENZONATATE 100MG CA,6400014,CDM,250,RC,,,Outpatient,,,2.05,1.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.64,80,,1.31,percent of total billed charges,80% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% 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,0.82,40,,0.66,percent of total billed charges,40% of total billed charges,0.76,1.64,
BACLOFEN 10MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,8.4,6.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,80,,5.38,percent of total billed charges,80% of total billed charges,3.13,37.27,,2.5,percent of total billed charges,37.27% of total billed charges,3.13,37.27,,2.5,percent of total billed charges,37.27% of total billed charges,3.13,37.27,,2.5,percent of total billed charges,37.27% 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,3.36,40,,2.69,percent of total billed charges,40% of total billed charges,3.13,6.72,
CEPHALEXIN 500MG CAP,6400014,CDM,250,RC,,,Outpatient,,,6.75,5.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.4,80,,4.32,percent of total billed charges,80% of total billed charges,2.52,37.27,,2.02,percent of total billed charges,37.27% of total billed charges,2.52,37.27,,2.02,percent of total billed charges,37.27% of total billed charges,2.52,37.27,,2.02,percent of total billed charges,37.27% 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,2.7,40,,2.16,percent of total billed charges,40% of total billed charges,2.52,5.4,
MONSEL'S SOL,5880901,CDM,637,RC,,,Outpatient,,,147.8,118.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118.24,80,,94.59,percent of total billed charges,80% of total billed charges,55.09,37.27,,44.07,percent of total billed charges,37.27% of total billed charges,55.09,37.27,,44.07,percent of total billed charges,37.27% of total billed charges,55.09,37.27,,44.07,percent of total billed charges,37.27% 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,59.12,40,,47.3,percent of total billed charges,40% of total billed charges,55.09,118.24,
PROTONIX 40MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,21.75,17.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,80,,13.92,percent of total billed charges,80% of total billed charges,8.11,37.27,,6.49,percent of total billed charges,37.27% of total billed charges,8.11,37.27,,6.49,percent of total billed charges,37.27% of total billed charges,8.11,37.27,,6.49,percent of total billed charges,37.27% 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,8.7,40,,6.96,percent of total billed charges,40% of total billed charges,8.11,17.4,
ROCEPHIN 2GM VIAL,6065130,CDM,636,RC,J0696,HCPCS,Outpatient,,,54.4,43.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,80,,34.82,percent of total billed charges,80% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% 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,21.76,40,,17.41,percent of total billed charges,40% of total billed charges,20.27,43.52,
ROCEPHIN 500MG VIAL,6065130,CDM,636,RC,J0696,HCPCS,Outpatient,,,54.4,43.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,80,,34.82,percent of total billed charges,80% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% 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,21.76,40,,17.41,percent of total billed charges,40% of total billed charges,20.27,43.52,
SLOW FE+FOLIC ACID T,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
FENTANYL 0.05MG/ML A,6065130,CDM,636,RC,J3010,HCPCS,Outpatient,,,13.1,10.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.48,80,,8.38,percent of total billed charges,80% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% 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,5.24,40,,4.19,percent of total billed charges,40% of total billed charges,4.88,10.48,
IBUPROFEN 100MG/5ML,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
DIPHENOXYLATE/ATR LI,6400014,CDM,250,RC,,,Outpatient,,,24.45,19.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.56,80,,15.65,percent of total billed charges,80% of total billed charges,9.11,37.27,,7.29,percent of total billed charges,37.27% of total billed charges,9.11,37.27,,7.29,percent of total billed charges,37.27% of total billed charges,9.11,37.27,,7.29,percent of total billed charges,37.27% 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,9.78,40,,7.82,percent of total billed charges,40% of total billed charges,9.11,19.56,
DOPAMINE 200MG/5CC V,6065130,CDM,636,RC,J1265,HCPCS,Outpatient,,,11.4,9.12,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
TELEPAQUE 500MG TABL,6400014,CDM,250,RC,,,Outpatient,,,15.09,12.07,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.07,80,,9.66,percent of total billed charges,80% of total billed charges,5.62,37.27,,4.5,percent of total billed charges,37.27% of total billed charges,5.62,37.27,,4.5,percent of total billed charges,37.27% of total billed charges,5.62,37.27,,4.5,percent of total billed charges,37.27% 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,6.04,40,,4.83,percent of total billed charges,40% of total billed charges,5.62,12.07,
AERO-CHAMBER (SPACER,6400014,CDM,250,RC,,,Outpatient,,,137.9,110.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.32,80,,88.26,percent of total billed charges,80% of total billed charges,51.4,37.27,,41.12,percent of total billed charges,37.27% of total billed charges,51.4,37.27,,41.12,percent of total billed charges,37.27% of total billed charges,51.4,37.27,,41.12,percent of total billed charges,37.27% 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,55.16,40,,44.13,percent of total billed charges,40% of total billed charges,51.4,110.32,
HYZAAR TABS 50/12.5,6400014,CDM,250,RC,,,Outpatient,,,10.9,8.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.72,80,,6.98,percent of total billed charges,80% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% 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,4.36,40,,3.49,percent of total billed charges,40% of total billed charges,4.06,8.72,
FORTAZ 1GM IV,6065130,CDM,636,RC,J0713,HCPCS,Outpatient,,,62.9,50.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.32,80,,40.26,percent of total billed charges,80% of total billed charges,23.44,37.27,,18.75,percent of total billed charges,37.27% of total billed charges,23.44,37.27,,18.75,percent of total billed charges,37.27% of total billed charges,23.44,37.27,,18.75,percent of total billed charges,37.27% 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,25.16,40,,20.13,percent of total billed charges,40% of total billed charges,23.44,50.32,
CEFZIL 250MG/5ML 50M,5880901,CDM,637,RC,,,Outpatient,,,140.25,112.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.2,80,,89.76,percent of total billed charges,80% of total billed charges,52.27,37.27,,41.82,percent of total billed charges,37.27% of total billed charges,52.27,37.27,,41.82,percent of total billed charges,37.27% of total billed charges,52.27,37.27,,41.82,percent of total billed charges,37.27% 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,56.1,40,,44.88,percent of total billed charges,40% of total billed charges,52.27,112.2,
MYLANTA II SUSP (OZ),6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
HALLS COUGH DROP,6400014,CDM,250,RC,,,Outpatient,,,4.55,3.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.64,80,,2.91,percent of total billed charges,80% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% 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,1.82,40,,1.46,percent of total billed charges,40% of total billed charges,1.7,3.64,
METOCLOPRAMIDE SYR 5,5880901,CDM,637,RC,,,Outpatient,,,21.75,17.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.4,80,,13.92,percent of total billed charges,80% of total billed charges,8.11,37.27,,6.49,percent of total billed charges,37.27% of total billed charges,8.11,37.27,,6.49,percent of total billed charges,37.27% of total billed charges,8.11,37.27,,6.49,percent of total billed charges,37.27% 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,8.7,40,,6.96,percent of total billed charges,40% of total billed charges,8.11,17.4,
CARAFATE 1GM TAB UD,6400014,CDM,250,RC,,,Outpatient,,,2.5,2.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
TYLENOL #2 TAB,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
RISPERDAL 0.5MG TABL,6400014,CDM,250,RC,,,Outpatient,,,43.85,35.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.08,80,,28.06,percent of total billed charges,80% of total billed charges,16.34,37.27,,13.07,percent of total billed charges,37.27% of total billed charges,16.34,37.27,,13.07,percent of total billed charges,37.27% of total billed charges,16.34,37.27,,13.07,percent of total billed charges,37.27% 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,17.54,40,,14.03,percent of total billed charges,40% of total billed charges,16.34,35.08,
LITHOBID 300MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CARAFATE SUSP,6400014,CDM,250,RC,,,Outpatient,,,46.6,37.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.28,80,,29.82,percent of total billed charges,80% of total billed charges,17.37,37.27,,13.9,percent of total billed charges,37.27% of total billed charges,17.37,37.27,,13.9,percent of total billed charges,37.27% of total billed charges,17.37,37.27,,13.9,percent of total billed charges,37.27% 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,18.64,40,,14.91,percent of total billed charges,40% of total billed charges,17.37,37.28,
NIMOTOP 30MG CAP,6400014,CDM,250,RC,,,Outpatient,,,65.55,52.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.44,80,,41.95,percent of total billed charges,80% of total billed charges,24.43,37.27,,19.54,percent of total billed charges,37.27% of total billed charges,24.43,37.27,,19.54,percent of total billed charges,37.27% of total billed charges,24.43,37.27,,19.54,percent of total billed charges,37.27% 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,26.22,40,,20.98,percent of total billed charges,40% of total billed charges,24.43,52.44,
MINERAL OIL STERILE,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
ACTIVATED CHARCOAL 2,6400014,CDM,250,RC,,,Outpatient,,,56.95,45.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.56,80,,36.45,percent of total billed charges,80% of total billed charges,21.23,37.27,,16.98,percent of total billed charges,37.27% of total billed charges,21.23,37.27,,16.98,percent of total billed charges,37.27% of total billed charges,21.23,37.27,,16.98,percent of total billed charges,37.27% 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,22.78,40,,18.22,percent of total billed charges,40% of total billed charges,21.23,45.56,
SENSORCAINE 0.5% 30C,6065130,CDM,636,RC,J0665,HCPCS,Outpatient,,,30.5,24.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.4,80,,19.52,percent of total billed charges,80% of total billed charges,11.37,37.27,,9.1,percent of total billed charges,37.27% of total billed charges,11.37,37.27,,9.1,percent of total billed charges,37.27% of total billed charges,11.37,37.27,,9.1,percent of total billed charges,37.27% of total billed charges,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.2,40,,9.76,percent of total billed charges,40% of total billed charges,0.01,24.4,
D 50 W 500CC,5753355,CDM,258,RC,,,Outpatient,,,35,28.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28,80,,22.4,percent of total billed charges,80% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% 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,14,40,,11.2,percent of total billed charges,40% of total billed charges,13.04,28,
ESTRATEST TAB,6400014,CDM,250,RC,,,Outpatient,,,13.15,10.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.52,80,,8.42,percent of total billed charges,80% of total billed charges,4.9,37.27,,3.92,percent of total billed charges,37.27% of total billed charges,4.9,37.27,,3.92,percent of total billed charges,37.27% of total billed charges,4.9,37.27,,3.92,percent of total billed charges,37.27% 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,5.26,40,,4.21,percent of total billed charges,40% of total billed charges,4.9,10.52,
KONSYL 6GM PKTS,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
LOTENSIN 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.5,2.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
MOTRIN 40MG/ML SUSP,6400014,CDM,250,RC,,,Outpatient,,,20.6,16.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.48,80,,13.18,percent of total billed charges,80% of total billed charges,7.68,37.27,,6.14,percent of total billed charges,37.27% of total billed charges,7.68,37.27,,6.14,percent of total billed charges,37.27% of total billed charges,7.68,37.27,,6.14,percent of total billed charges,37.27% 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,8.24,40,,6.59,percent of total billed charges,40% of total billed charges,7.68,16.48,
DEPAKOTE 125MG SPRIN,6400014,CDM,250,RC,,,Outpatient,,,4.85,3.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.88,80,,3.1,percent of total billed charges,80% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% 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,1.94,40,,1.55,percent of total billed charges,40% of total billed charges,1.81,3.88,
ARAVA 20MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,112.45,89.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.96,80,,71.97,percent of total billed charges,80% of total billed charges,41.91,37.27,,33.53,percent of total billed charges,37.27% of total billed charges,41.91,37.27,,33.53,percent of total billed charges,37.27% of total billed charges,41.91,37.27,,33.53,percent of total billed charges,37.27% 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,44.98,40,,35.98,percent of total billed charges,40% of total billed charges,41.91,89.96,
LOVENOX 60MG PREFILL,6065130,CDM,636,RC,J1650,HCPCS,Outpatient,,,184.75,147.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.8,80,,118.24,percent of total billed charges,80% of total billed charges,68.86,37.27,,55.09,percent of total billed charges,37.27% of total billed charges,68.86,37.27,,55.09,percent of total billed charges,37.27% of total billed charges,68.86,37.27,,55.09,percent of total billed charges,37.27% 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,73.9,40,,59.12,percent of total billed charges,40% of total billed charges,68.86,147.8,
FORTAZ: 1 GM IM/IV,6065130,CDM,636,RC,J0713,HCPCS,Outpatient,,,61,48.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% 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,24.4,40,,19.52,percent of total billed charges,40% of total billed charges,22.73,48.8,
XANAX 1MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.3,2.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.64,80,,2.11,percent of total billed charges,80% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% 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,1.32,40,,1.06,percent of total billed charges,40% of total billed charges,1.23,2.64,
DIAZEPAM SYRINGE,6065130,CDM,636,RC,J3360,HCPCS,Outpatient,,,133.7,106.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.96,80,,85.57,percent of total billed charges,80% of total billed charges,49.83,37.27,,39.86,percent of total billed charges,37.27% of total billed charges,49.83,37.27,,39.86,percent of total billed charges,37.27% of total billed charges,49.83,37.27,,39.86,percent of total billed charges,37.27% 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,53.48,40,,42.78,percent of total billed charges,40% of total billed charges,49.83,106.96,
REGRANEX 0.01% GEL (,6400014,CDM,250,RC,,,Outpatient,,,1058.4,846.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,846.72,80,,677.38,percent of total billed charges,80% of total billed charges,394.47,37.27,,315.58,percent of total billed charges,37.27% of total billed charges,394.47,37.27,,315.58,percent of total billed charges,37.27% of total billed charges,394.47,37.27,,315.58,percent of total billed charges,37.27% 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,423.36,40,,338.69,percent of total billed charges,40% of total billed charges,394.47,846.72,
PROCRIT 4000U X4,6065130,CDM,636,RC,J0885,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,7.53,300,
BUMEX 0.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
BUMEX 1.5 MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
VERSED 1CC-MG,6065130,CDM,636,RC,J2250,HCPCS,Outpatient,,,31.85,25.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.48,80,,20.38,percent of total billed charges,80% of total billed charges,11.87,37.27,,9.5,percent of total billed charges,37.27% of total billed charges,11.87,37.27,,9.5,percent of total billed charges,37.27% of total billed charges,11.87,37.27,,9.5,percent of total billed charges,37.27% 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,12.74,40,,10.19,percent of total billed charges,40% of total billed charges,11.87,25.48,
MICRO-K 10MEQ,6400014,CDM,250,RC,,,Outpatient,,,3.35,2.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.68,80,,2.14,percent of total billed charges,80% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% 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,1.34,40,,1.07,percent of total billed charges,40% of total billed charges,1.25,2.68,
ATIVAN 0.5 MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.8,1.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.44,80,,1.15,percent of total billed charges,80% of total billed charges,0.67,37.27,,0.54,percent of total billed charges,37.27% of total billed charges,0.67,37.27,,0.54,percent of total billed charges,37.27% of total billed charges,0.67,37.27,,0.54,percent of total billed charges,37.27% 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,0.72,40,,0.58,percent of total billed charges,40% of total billed charges,0.67,1.44,
LACRI-LUBE U/D,6400014,CDM,250,RC,,,Outpatient,,,6.95,5.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.56,80,,4.45,percent of total billed charges,80% of total billed charges,2.59,37.27,,2.07,percent of total billed charges,37.27% of total billed charges,2.59,37.27,,2.07,percent of total billed charges,37.27% of total billed charges,2.59,37.27,,2.07,percent of total billed charges,37.27% 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,2.78,40,,2.22,percent of total billed charges,40% of total billed charges,2.59,5.56,
ANZEMET 12.5 MG/ML A,6400014,CDM,250,RC,J1260,HCPCS,Outpatient,,,95.3,76.24,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.24,80,,60.99,percent of total billed charges,80% of total billed charges,35.52,37.27,,28.42,percent of total billed charges,37.27% of total billed charges,35.52,37.27,,28.42,percent of total billed charges,37.27% of total billed charges,35.52,37.27,,28.42,percent of total billed charges,37.27% 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,38.12,40,,30.5,percent of total billed charges,40% of total billed charges,35.52,76.24,
PROCARDIA 10MG U/D,6400014,CDM,250,RC,,,Outpatient,,,4.4,3.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,80,,2.82,percent of total billed charges,80% of total billed charges,1.64,37.27,,1.31,percent of total billed charges,37.27% of total billed charges,1.64,37.27,,1.31,percent of total billed charges,37.27% of total billed charges,1.64,37.27,,1.31,percent of total billed charges,37.27% 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,1.76,40,,1.41,percent of total billed charges,40% of total billed charges,1.64,3.52,
DIGOXIN AMP,6065130,CDM,636,RC,J1160,HCPCS,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
VANCOCIN ORAL SOLN 1,6400014,CDM,250,RC,,,Outpatient,,,651.6,521.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,521.28,80,,417.02,percent of total billed charges,80% of total billed charges,242.85,37.27,,194.28,percent of total billed charges,37.27% of total billed charges,242.85,37.27,,194.28,percent of total billed charges,37.27% of total billed charges,242.85,37.27,,194.28,percent of total billed charges,37.27% 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,260.64,40,,208.51,percent of total billed charges,40% of total billed charges,242.85,521.28,
PLAQUENIL 200MG,6400014,CDM,250,RC,,,Outpatient,,,14.4,11.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,80,,9.22,percent of total billed charges,80% of total billed charges,5.37,37.27,,4.3,percent of total billed charges,37.27% of total billed charges,5.37,37.27,,4.3,percent of total billed charges,37.27% of total billed charges,5.37,37.27,,4.3,percent of total billed charges,37.27% 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,5.76,40,,4.61,percent of total billed charges,40% of total billed charges,5.37,11.52,
TENORETIC- 50,6400014,CDM,250,RC,,,Outpatient,,,3.65,2.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.92,80,,2.34,percent of total billed charges,80% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% 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,1.46,40,,1.17,percent of total billed charges,40% of total billed charges,1.36,2.92,
GENTAMICIN 80MG/2ML,6065130,CDM,636,RC,J1580,HCPCS,Outpatient,,,38.95,31.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.16,80,,24.93,percent of total billed charges,80% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% 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,15.58,40,,12.46,percent of total billed charges,40% of total billed charges,14.52,31.16,
NASALCROM INHALER,6400014,CDM,250,RC,,,Outpatient,,,55.65,44.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.52,80,,35.62,percent of total billed charges,80% of total billed charges,20.74,37.27,,16.59,percent of total billed charges,37.27% of total billed charges,20.74,37.27,,16.59,percent of total billed charges,37.27% of total billed charges,20.74,37.27,,16.59,percent of total billed charges,37.27% 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,22.26,40,,17.81,percent of total billed charges,40% of total billed charges,20.74,44.52,
TEARS NATURALE,6400014,CDM,250,RC,,,Outpatient,,,22.9,18.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.32,80,,14.66,percent of total billed charges,80% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% 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,9.16,40,,7.33,percent of total billed charges,40% of total billed charges,8.53,18.32,
MVI-12 VIAL,6400014,CDM,250,RC,,,Outpatient,,,62.9,50.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.32,80,,40.26,percent of total billed charges,80% of total billed charges,23.44,37.27,,18.75,percent of total billed charges,37.27% of total billed charges,23.44,37.27,,18.75,percent of total billed charges,37.27% of total billed charges,23.44,37.27,,18.75,percent of total billed charges,37.27% 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,25.16,40,,20.13,percent of total billed charges,40% of total billed charges,23.44,50.32,
CARDURA 4MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.4,2.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.72,80,,2.18,percent of total billed charges,80% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% 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,1.36,40,,1.09,percent of total billed charges,40% of total billed charges,1.27,2.72,
DETROL 2MG TAB (TOLT,6400014,CDM,250,RC,,,Outpatient,,,35.4,28.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.32,80,,22.66,percent of total billed charges,80% of total billed charges,13.19,37.27,,10.55,percent of total billed charges,37.27% of total billed charges,13.19,37.27,,10.55,percent of total billed charges,37.27% of total billed charges,13.19,37.27,,10.55,percent of total billed charges,37.27% 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,14.16,40,,11.33,percent of total billed charges,40% of total billed charges,13.19,28.32,
PROZAC LIQUID 20MG/5,6400014,CDM,250,RC,,,Outpatient,,,93,74.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% 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,37.2,40,,29.76,percent of total billed charges,40% of total billed charges,34.66,74.4,
HALCION 0.25MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,2.4,1.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,80,,1.54,percent of total billed charges,80% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% 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,0.96,40,,0.77,percent of total billed charges,40% of total billed charges,0.89,1.92,
LIDOCAINE W/EPI,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,33.6,26.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,80,,21.5,percent of total billed charges,80% of total billed charges,12.52,37.27,,10.02,percent of total billed charges,37.27% of total billed charges,12.52,37.27,,10.02,percent of total billed charges,37.27% of total billed charges,12.52,37.27,,10.02,percent of total billed charges,37.27% 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,13.44,40,,10.75,percent of total billed charges,40% of total billed charges,12.52,26.88,
MILK OF MAGNESIA 1OZ,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
PROMETHAZINE 25MG/1M,6065130,CDM,636,RC,J2550,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
PROMETHAZINE 50MG,6065130,CDM,636,RC,J2550,HCPCS,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
CHLORPROMAZINE INJ,6065130,CDM,636,RC,J3230,HCPCS,Outpatient,,,118.2,94.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.56,80,,75.65,percent of total billed charges,80% of total billed charges,44.05,37.27,,35.24,percent of total billed charges,37.27% of total billed charges,44.05,37.27,,35.24,percent of total billed charges,37.27% of total billed charges,44.05,37.27,,35.24,percent of total billed charges,37.27% 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,47.28,40,,37.82,percent of total billed charges,40% of total billed charges,44.05,94.56,
DEXAMETHASONE INJ:1M,6065130,CDM,636,RC,J1100,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
BISACODYL TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CYPROHEPTADINE 4MG U,6400014,CDM,250,RC,,,Outpatient,,,3.6,2.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,80,,2.3,percent of total billed charges,80% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% 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,1.44,40,,1.15,percent of total billed charges,40% of total billed charges,1.34,2.88,
QUINIDINE SULFATE 20,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CHLORPROMAZINE,6400014,CDM,250,RC,,,Outpatient,,,20.95,16.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.76,80,,13.41,percent of total billed charges,80% of total billed charges,7.81,37.27,,6.25,percent of total billed charges,37.27% of total billed charges,7.81,37.27,,6.25,percent of total billed charges,37.27% of total billed charges,7.81,37.27,,6.25,percent of total billed charges,37.27% 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,8.38,40,,6.7,percent of total billed charges,40% of total billed charges,7.81,16.76,
METHADONE TAB 10MG,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
METHYLDOPA 250MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
HYDROXYZINE 25MG CAP,6400014,CDM,250,RC,,,Outpatient,,,2.05,1.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.64,80,,1.31,percent of total billed charges,80% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% 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,0.82,40,,0.66,percent of total billed charges,40% of total billed charges,0.76,1.64,
DICYCLOMINE 10MG CAP,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
D51/2NS 1000ML/KCL 2,5753355,CDM,258,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
COZAAR 25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.76,3.01,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.01,80,,2.41,percent of total billed charges,80% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% 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,1.5,40,,1.2,percent of total billed charges,40% of total billed charges,1.4,3.01,
NS 1000ML/KCL 40MEQ,5753355,CDM,258,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
DEXAMETHASONE TAB 4M,6400014,CDM,250,RC,,,Outpatient,,,4.1,3.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.28,80,,2.62,percent of total billed charges,80% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% 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,1.64,40,,1.31,percent of total billed charges,40% of total billed charges,1.53,3.28,
MEPROBAMATE 400MG TA,6400014,CDM,250,RC,,,Outpatient,,,6.25,5.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5,80,,4,percent of total billed charges,80% of total billed charges,2.33,37.27,,1.86,percent of total billed charges,37.27% of total billed charges,2.33,37.27,,1.86,percent of total billed charges,37.27% of total billed charges,2.33,37.27,,1.86,percent of total billed charges,37.27% 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,2.5,40,,2,percent of total billed charges,40% of total billed charges,2.33,5,
PRECOSE TAB 50 MG,6400014,CDM,250,RC,,,Outpatient,,,4.1,3.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.28,80,,2.62,percent of total billed charges,80% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% 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,1.64,40,,1.31,percent of total billed charges,40% of total billed charges,1.53,3.28,
D5NS 1000ML/KCL 40ME,5753355,CDM,258,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
AMITRIPTYLINE 10MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
HCTZ 25MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
INDOMETHACIN 25MG CA,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
SENSORCAINE 0.5%W/EP,6065130,CDM,636,RC,J0665,HCPCS,Outpatient,,,46.75,37.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.4,80,,29.92,percent of total billed charges,80% of total billed charges,17.42,37.27,,13.94,percent of total billed charges,37.27% of total billed charges,17.42,37.27,,13.94,percent of total billed charges,37.27% of total billed charges,17.42,37.27,,13.94,percent of total billed charges,37.27% of total billed charges,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.7,40,,14.96,percent of total billed charges,40% of total billed charges,0.01,37.4,
CHLORDIAZEPOXIDE 10M,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
CHLORDIAZEPOXIDE 25M,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
PROMETHAZINE 25MG PO,6400014,CDM,250,RC,,,Outpatient,,,2.05,1.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.64,80,,1.31,percent of total billed charges,80% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% 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,0.82,40,,0.66,percent of total billed charges,40% of total billed charges,0.76,1.64,
BETHANECHOL 25MG,6400014,CDM,250,RC,,,Outpatient,,,22.8,18.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,80,,14.59,percent of total billed charges,80% of total billed charges,8.5,37.27,,6.8,percent of total billed charges,37.27% of total billed charges,8.5,37.27,,6.8,percent of total billed charges,37.27% of total billed charges,8.5,37.27,,6.8,percent of total billed charges,37.27% 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,9.12,40,,7.3,percent of total billed charges,40% of total billed charges,8.5,18.24,
FUROSEMIDE 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
FUROSEMIDE 40MG TABL,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CHLORPROPAMIDE 250MG,6400014,CDM,250,RC,,,Outpatient,,,8.65,6.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.92,80,,5.54,percent of total billed charges,80% of total billed charges,3.22,37.27,,2.58,percent of total billed charges,37.27% of total billed charges,3.22,37.27,,2.58,percent of total billed charges,37.27% of total billed charges,3.22,37.27,,2.58,percent of total billed charges,37.27% 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,3.46,40,,2.77,percent of total billed charges,40% of total billed charges,3.22,6.92,
NASACORT-A Q INHALER,6400014,CDM,250,RC,,,Outpatient,,,355.75,284.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,284.6,80,,227.68,percent of total billed charges,80% of total billed charges,132.59,37.27,,106.07,percent of total billed charges,37.27% of total billed charges,132.59,37.27,,106.07,percent of total billed charges,37.27% of total billed charges,132.59,37.27,,106.07,percent of total billed charges,37.27% 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,142.3,40,,113.84,percent of total billed charges,40% of total billed charges,132.59,284.6,
HUMULIN R INSULIN,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,64.2,51.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.36,80,,41.09,percent of total billed charges,80% of total billed charges,23.93,37.27,,19.14,percent of total billed charges,37.27% of total billed charges,23.93,37.27,,19.14,percent of total billed charges,37.27% of total billed charges,23.93,37.27,,19.14,percent of total billed charges,37.27% 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,25.68,40,,20.54,percent of total billed charges,40% of total billed charges,23.93,51.36,
HUMULIN N INSULIN,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
INSULIN NPH,6400014,CDM,250,RC,,,Outpatient,,,13.13,10.50,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.5,80,,8.4,percent of total billed charges,80% of total billed charges,4.89,37.27,,3.91,percent of total billed charges,37.27% of total billed charges,4.89,37.27,,3.91,percent of total billed charges,37.27% of total billed charges,4.89,37.27,,3.91,percent of total billed charges,37.27% 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,5.25,40,,4.2,percent of total billed charges,40% of total billed charges,4.89,10.5,
NPH-BEEF INSULIN,6400014,CDM,250,RC,,,Outpatient,,,18.06,14.45,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.45,80,,11.56,percent of total billed charges,80% of total billed charges,6.73,37.27,,5.38,percent of total billed charges,37.27% of total billed charges,6.73,37.27,,5.38,percent of total billed charges,37.27% of total billed charges,6.73,37.27,,5.38,percent of total billed charges,37.27% 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,7.22,40,,5.78,percent of total billed charges,40% of total billed charges,6.73,14.45,
IV STERILE WATER FOR,5645742,CDM,270,RC,,,Outpatient,,,40.2,32.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.16,80,,25.73,percent of total billed charges,80% of total billed charges,14.98,37.27,,11.98,percent of total billed charges,37.27% of total billed charges,14.98,37.27,,11.98,percent of total billed charges,37.27% of total billed charges,14.98,37.27,,11.98,percent of total billed charges,37.27% 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,16.08,40,,12.86,percent of total billed charges,40% of total billed charges,14.98,32.16,
FLEET PEDIATRIC ENEM,5880901,CDM,637,RC,,,Outpatient,,,15.9,12.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.72,80,,10.18,percent of total billed charges,80% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% 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,6.36,40,,5.09,percent of total billed charges,40% of total billed charges,5.93,12.72,
NOCTEC LIQUID 5ML,6400014,CDM,250,RC,,,Outpatient,,,1.9,1.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.52,80,,1.22,percent of total billed charges,80% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% 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,0.76,40,,0.61,percent of total billed charges,40% of total billed charges,0.71,1.52,
ATROPINE 0.5 MG SING,6065130,CDM,636,RC,J0461,HCPCS,Outpatient,,,65.9,52.72,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.72,80,,42.18,percent of total billed charges,80% of total billed charges,24.56,37.27,,19.65,percent of total billed charges,37.27% of total billed charges,24.56,37.27,,19.65,percent of total billed charges,37.27% of total billed charges,24.56,37.27,,19.65,percent of total billed charges,37.27% 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,26.36,40,,21.09,percent of total billed charges,40% of total billed charges,24.56,52.72,
FLORINEF 0.1MG,6400014,CDM,250,RC,,,Outpatient,,,3.6,2.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,80,,2.3,percent of total billed charges,80% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% 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,1.44,40,,1.15,percent of total billed charges,40% of total billed charges,1.34,2.88,
TALWIN NX TABLET,6400014,CDM,250,RC,,,Outpatient,,,2.95,2.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,80,,1.89,percent of total billed charges,80% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% 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,1.18,40,,0.94,percent of total billed charges,40% of total billed charges,1.1,2.36,
NORMODYNE TAB 200MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
NITRO-BID OINT UD 1G,6400014,CDM,250,RC,,,Outpatient,,,10.3,8.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.24,80,,6.59,percent of total billed charges,80% of total billed charges,3.84,37.27,,3.07,percent of total billed charges,37.27% of total billed charges,3.84,37.27,,3.07,percent of total billed charges,37.27% of total billed charges,3.84,37.27,,3.07,percent of total billed charges,37.27% 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,4.12,40,,3.3,percent of total billed charges,40% of total billed charges,3.84,8.24,
FEMARA 2.5MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,20.59,16.47,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.47,80,,13.18,percent of total billed charges,80% of total billed charges,7.67,37.27,,6.14,percent of total billed charges,37.27% of total billed charges,7.67,37.27,,6.14,percent of total billed charges,37.27% of total billed charges,7.67,37.27,,6.14,percent of total billed charges,37.27% 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,8.24,40,,6.59,percent of total billed charges,40% of total billed charges,7.67,16.47,
TAGAMET 400MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,11.35,9.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.08,80,,7.26,percent of total billed charges,80% of total billed charges,4.23,37.27,,3.38,percent of total billed charges,37.27% of total billed charges,4.23,37.27,,3.38,percent of total billed charges,37.27% of total billed charges,4.23,37.27,,3.38,percent of total billed charges,37.27% 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,4.54,40,,3.63,percent of total billed charges,40% of total billed charges,4.23,9.08,
ZOVIRAX 200MG CAPSUL,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
LEVAQUIN INJ 500MG V,6065130,CDM,636,RC,J1956,HCPCS,Outpatient,,,152.55,122.04,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.04,80,,97.63,percent of total billed charges,80% of total billed charges,56.86,37.27,,45.49,percent of total billed charges,37.27% of total billed charges,56.86,37.27,,45.49,percent of total billed charges,37.27% of total billed charges,56.86,37.27,,45.49,percent of total billed charges,37.27% 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,61.02,40,,48.82,percent of total billed charges,40% of total billed charges,56.86,122.04,
METRONIDAZOLE 500MG,5880901,CDM,637,RC,,,Outpatient,,,4.35,3.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.48,80,,2.78,percent of total billed charges,80% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% 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,1.74,40,,1.39,percent of total billed charges,40% of total billed charges,1.62,3.48,
MIOSTAT OPHTH DROPS,6400014,CDM,250,RC,,,Outpatient,,,137.8,110.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.24,80,,88.19,percent of total billed charges,80% of total billed charges,51.36,37.27,,41.09,percent of total billed charges,37.27% of total billed charges,51.36,37.27,,41.09,percent of total billed charges,37.27% of total billed charges,51.36,37.27,,41.09,percent of total billed charges,37.27% 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,55.12,40,,44.1,percent of total billed charges,40% of total billed charges,51.36,110.24,
LOZOL 2.5MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,2.85,2.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,80,,1.82,percent of total billed charges,80% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% 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,1.14,40,,0.91,percent of total billed charges,40% of total billed charges,1.06,2.28,
VEXOL SUSP.,6400014,CDM,250,RC,,,Outpatient,,,189.3,151.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.44,80,,121.15,percent of total billed charges,80% of total billed charges,70.55,37.27,,56.44,percent of total billed charges,37.27% of total billed charges,70.55,37.27,,56.44,percent of total billed charges,37.27% of total billed charges,70.55,37.27,,56.44,percent of total billed charges,37.27% 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,75.72,40,,60.58,percent of total billed charges,40% of total billed charges,70.55,151.44,
DIABETA 2.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
DIABETA 5MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,2.8,2.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,80,,1.79,percent of total billed charges,80% of total billed charges,1.04,37.27,,0.83,percent of total billed charges,37.27% of total billed charges,1.04,37.27,,0.83,percent of total billed charges,37.27% of total billed charges,1.04,37.27,,0.83,percent of total billed charges,37.27% 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,1.12,40,,0.9,percent of total billed charges,40% of total billed charges,1.04,2.24,
TRENTAL 400MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,1.7,1.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.36,80,,1.09,percent of total billed charges,80% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% 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,0.68,40,,0.54,percent of total billed charges,40% of total billed charges,0.63,1.36,
SLO BID 300MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
TAMIFLU SUSP 12MG/ML,6400014,CDM,250,RC,,,Outpatient,,,36.9,29.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.52,80,,23.62,percent of total billed charges,80% of total billed charges,13.75,37.27,,11,percent of total billed charges,37.27% of total billed charges,13.75,37.27,,11,percent of total billed charges,37.27% of total billed charges,13.75,37.27,,11,percent of total billed charges,37.27% 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,14.76,40,,11.81,percent of total billed charges,40% of total billed charges,13.75,29.52,
ANAPROX 275MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,2.6,2.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.08,80,,1.66,percent of total billed charges,80% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% 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,1.04,40,,0.83,percent of total billed charges,40% of total billed charges,0.97,2.08,
MYLANTA 5OZ SUSP,6400014,CDM,250,RC,,,Outpatient,,,9.2,7.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,80,,5.89,percent of total billed charges,80% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% 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,3.68,40,,2.94,percent of total billed charges,40% of total billed charges,3.43,7.36,
NORGESIC FORTE TAB,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
NORFLEX TAB 100MG,6400014,CDM,250,RC,,,Outpatient,,,7.45,5.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.96,80,,4.77,percent of total billed charges,80% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% 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,2.98,40,,2.38,percent of total billed charges,40% of total billed charges,2.78,5.96,
VASOTEC 1.25MG/1ML I,6400014,CDM,250,RC,,,Outpatient,,,47.2,37.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,80,,30.21,percent of total billed charges,80% of total billed charges,17.59,37.27,,14.07,percent of total billed charges,37.27% of total billed charges,17.59,37.27,,14.07,percent of total billed charges,37.27% of total billed charges,17.59,37.27,,14.07,percent of total billed charges,37.27% 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,18.88,40,,15.1,percent of total billed charges,40% of total billed charges,17.59,37.76,
PEPTAMEN 8OZ,6400014,CDM,250,RC,,,Outpatient,,,31.1,24.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.88,80,,19.9,percent of total billed charges,80% of total billed charges,11.59,37.27,,9.27,percent of total billed charges,37.27% of total billed charges,11.59,37.27,,9.27,percent of total billed charges,37.27% of total billed charges,11.59,37.27,,9.27,percent of total billed charges,37.27% 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,12.44,40,,9.95,percent of total billed charges,40% of total billed charges,11.59,24.88,
IV D5W 50CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
GLUTOSE 15GM TUBE GL,6400014,CDM,250,RC,,,Outpatient,,,13.7,10.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.96,80,,8.77,percent of total billed charges,80% of total billed charges,5.11,37.27,,4.09,percent of total billed charges,37.27% of total billed charges,5.11,37.27,,4.09,percent of total billed charges,37.27% of total billed charges,5.11,37.27,,4.09,percent of total billed charges,37.27% 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,5.48,40,,4.38,percent of total billed charges,40% of total billed charges,5.11,10.96,
HYDREA 500MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,4.5,3.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,80,,2.88,percent of total billed charges,80% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% 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,1.8,40,,1.44,percent of total billed charges,40% of total billed charges,1.68,3.6,
ELOCON LOTION 30ML,6400014,CDM,250,RC,,,Outpatient,,,77.65,62.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.12,80,,49.7,percent of total billed charges,80% of total billed charges,28.94,37.27,,23.15,percent of total billed charges,37.27% of total billed charges,28.94,37.27,,23.15,percent of total billed charges,37.27% of total billed charges,28.94,37.27,,23.15,percent of total billed charges,37.27% 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,31.06,40,,24.85,percent of total billed charges,40% of total billed charges,28.94,62.12,
DURAGESIC 25MCG/HR P,6400014,CDM,250,RC,,,Outpatient,,,160.35,128.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.28,80,,102.62,percent of total billed charges,80% of total billed charges,59.76,37.27,,47.81,percent of total billed charges,37.27% of total billed charges,59.76,37.27,,47.81,percent of total billed charges,37.27% of total billed charges,59.76,37.27,,47.81,percent of total billed charges,37.27% 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,64.14,40,,51.31,percent of total billed charges,40% of total billed charges,59.76,128.28,
GLYNASE 3MG TAB U/D,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
CODIMAL DM,6400014,CDM,250,RC,,,Outpatient,,,20.4,16.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.32,80,,13.06,percent of total billed charges,80% of total billed charges,7.6,37.27,,6.08,percent of total billed charges,37.27% of total billed charges,7.6,37.27,,6.08,percent of total billed charges,37.27% of total billed charges,7.6,37.27,,6.08,percent of total billed charges,37.27% 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,8.16,40,,6.53,percent of total billed charges,40% of total billed charges,7.6,16.32,
PREMPRO 0.625MG/2.5M,6400014,CDM,250,RC,,,Outpatient,,,16.6,13.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.28,80,,10.62,percent of total billed charges,80% of total billed charges,6.19,37.27,,4.95,percent of total billed charges,37.27% of total billed charges,6.19,37.27,,4.95,percent of total billed charges,37.27% of total billed charges,6.19,37.27,,4.95,percent of total billed charges,37.27% 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,6.64,40,,5.31,percent of total billed charges,40% of total billed charges,6.19,13.28,
TIAZAC 180MG CAP DIL,6400014,CDM,250,RC,,,Outpatient,,,6.45,5.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.16,80,,4.13,percent of total billed charges,80% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% 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,2.58,40,,2.06,percent of total billed charges,40% of total billed charges,2.4,5.16,
TIAZAC 240MG CAP DIL,6400014,CDM,250,RC,,,Outpatient,,,9.15,7.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.32,80,,5.86,percent of total billed charges,80% of total billed charges,3.41,37.27,,2.73,percent of total billed charges,37.27% of total billed charges,3.41,37.27,,2.73,percent of total billed charges,37.27% of total billed charges,3.41,37.27,,2.73,percent of total billed charges,37.27% 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,3.66,40,,2.93,percent of total billed charges,40% of total billed charges,3.41,7.32,
SULAR 10MG TABLET (N,6400014,CDM,250,RC,,,Outpatient,,,2.71,2.17,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.17,80,,1.74,percent of total billed charges,80% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% 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,1.08,40,,0.86,percent of total billed charges,40% of total billed charges,1.01,2.17,
MIRAPEX TAB 0.25MG,6400014,CDM,250,RC,,,Outpatient,,,13.5,10.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,80,,8.64,percent of total billed charges,80% of total billed charges,5.03,37.27,,4.02,percent of total billed charges,37.27% of total billed charges,5.03,37.27,,4.02,percent of total billed charges,37.27% of total billed charges,5.03,37.27,,4.02,percent of total billed charges,37.27% 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,5.4,40,,4.32,percent of total billed charges,40% of total billed charges,5.03,10.8,
CELEXA 40MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,12.35,9.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.88,80,,7.9,percent of total billed charges,80% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% 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,4.94,40,,3.95,percent of total billed charges,40% of total billed charges,4.6,9.88,
VITAMIN B12 1000MCG/,6065130,CDM,636,RC,J3420,HCPCS,Outpatient,,,40.8,32.64,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.64,80,,26.11,percent of total billed charges,80% of total billed charges,15.21,37.27,,12.17,percent of total billed charges,37.27% of total billed charges,15.21,37.27,,12.17,percent of total billed charges,37.27% of total billed charges,15.21,37.27,,12.17,percent of total billed charges,37.27% 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,16.32,40,,13.06,percent of total billed charges,40% of total billed charges,15.21,32.64,
NO DOZ 200MG CAP,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
MIACALCIN 200IU/ML,6065130,CDM,636,RC,J0630,HCPCS,Outpatient,,,5962.1,4769.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4769.68,80,,3815.74,percent of total billed charges,80% of total billed charges,2222.07,37.27,,1777.66,percent of total billed charges,37.27% of total billed charges,2222.07,37.27,,1777.66,percent of total billed charges,37.27% of total billed charges,2222.07,37.27,,1777.66,percent of total billed charges,37.27% of total billed charges,1173.06,100,,,fee schedule,100% of APC rate,1173.06,100,,,fee schedule,100% of APC rate,1173.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1173.06,100,,,fee schedule,100% of APC rate,1173.06,100,,,fee schedule,100% of APC rate,1173.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2384.84,40,,1907.87,percent of total billed charges,40% of total billed charges,1173.06,4769.68,
MIACALCIN 200U NASAL,6400014,CDM,250,RC,,,Outpatient,,,164.6,131.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.68,80,,105.34,percent of total billed charges,80% of total billed charges,61.35,37.27,,49.08,percent of total billed charges,37.27% of total billed charges,61.35,37.27,,49.08,percent of total billed charges,37.27% of total billed charges,61.35,37.27,,49.08,percent of total billed charges,37.27% 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,65.84,40,,52.67,percent of total billed charges,40% of total billed charges,61.35,131.68,
TUMS 500 TAB CHEWABL,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
OS-CAL 500+D TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PERI-DOS 100/30 CAP,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
CEFACLOR 250MG CAP,6400014,CDM,250,RC,,,Outpatient,,,7.75,6.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.2,80,,4.96,percent of total billed charges,80% of total billed charges,2.89,37.27,,2.31,percent of total billed charges,37.27% of total billed charges,2.89,37.27,,2.31,percent of total billed charges,37.27% of total billed charges,2.89,37.27,,2.31,percent of total billed charges,37.27% 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,3.1,40,,2.48,percent of total billed charges,40% of total billed charges,2.89,6.2,
CLAFORAN 2GM ADV VIA,6065130,CDM,636,RC,J0698,HCPCS,Outpatient,,,103.7,82.96,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.96,80,,66.37,percent of total billed charges,80% of total billed charges,38.65,37.27,,30.92,percent of total billed charges,37.27% of total billed charges,38.65,37.27,,30.92,percent of total billed charges,37.27% of total billed charges,38.65,37.27,,30.92,percent of total billed charges,37.27% 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,41.48,40,,33.18,percent of total billed charges,40% of total billed charges,38.65,82.96,
TAZIDIME 1GM ADD-VAN,6400014,CDM,250,RC,,,Outpatient,,,62.9,50.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.32,80,,40.26,percent of total billed charges,80% of total billed charges,23.44,37.27,,18.75,percent of total billed charges,37.27% of total billed charges,23.44,37.27,,18.75,percent of total billed charges,37.27% of total billed charges,23.44,37.27,,18.75,percent of total billed charges,37.27% 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,25.16,40,,20.13,percent of total billed charges,40% of total billed charges,23.44,50.32,
CEPHALEXIN 250MG/5ML,5880901,CDM,637,RC,,,Outpatient,,,103.5,82.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.8,80,,66.24,percent of total billed charges,80% of total billed charges,38.57,37.27,,30.86,percent of total billed charges,37.27% of total billed charges,38.57,37.27,,30.86,percent of total billed charges,37.27% of total billed charges,38.57,37.27,,30.86,percent of total billed charges,37.27% 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,41.4,40,,33.12,percent of total billed charges,40% of total billed charges,38.57,82.8,
PANCREATIC ENZYME CA,6400014,CDM,250,RC,,,Outpatient,,,3.45,2.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.76,80,,2.21,percent of total billed charges,80% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% 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,1.38,40,,1.1,percent of total billed charges,40% of total billed charges,1.29,2.76,
ATENOLOL 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.85,2.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,80,,1.82,percent of total billed charges,80% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% 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,1.14,40,,0.91,percent of total billed charges,40% of total billed charges,1.06,2.28,
ANTISPASMODIC ELIXIR,6400014,CDM,250,RC,,,Outpatient,,,12.4,9.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,80,,7.94,percent of total billed charges,80% of total billed charges,4.62,37.27,,3.7,percent of total billed charges,37.27% of total billed charges,4.62,37.27,,3.7,percent of total billed charges,37.27% of total billed charges,4.62,37.27,,3.7,percent of total billed charges,37.27% 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,4.96,40,,3.97,percent of total billed charges,40% of total billed charges,4.62,9.92,
LOTENSIN 10MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,3.6,2.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,80,,2.3,percent of total billed charges,80% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% 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,1.44,40,,1.15,percent of total billed charges,40% of total billed charges,1.34,2.88,
LOTREL 5/10MG CAP,6400014,CDM,250,RC,,,Outpatient,,,9.2,7.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,80,,5.89,percent of total billed charges,80% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% 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,3.68,40,,2.94,percent of total billed charges,40% of total billed charges,3.43,7.36,
SENSORCAINE 0.25% AM,6065130,CDM,636,RC,J0665,HCPCS,Outpatient,,,20.9,16.72,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.72,80,,13.38,percent of total billed charges,80% of total billed charges,7.79,37.27,,6.23,percent of total billed charges,37.27% of total billed charges,7.79,37.27,,6.23,percent of total billed charges,37.27% of total billed charges,7.79,37.27,,6.23,percent of total billed charges,37.27% of total billed charges,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.36,40,,6.69,percent of total billed charges,40% of total billed charges,0.01,16.72,
SENSORCAINE 0.75% VI,6065130,CDM,636,RC,J0665,HCPCS,Outpatient,,,37.76,30.21,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.21,80,,24.17,percent of total billed charges,80% of total billed charges,14.07,37.27,,11.26,percent of total billed charges,37.27% of total billed charges,14.07,37.27,,11.26,percent of total billed charges,37.27% of total billed charges,14.07,37.27,,11.26,percent of total billed charges,37.27% of total billed charges,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.1,40,,12.08,percent of total billed charges,40% of total billed charges,0.01,30.21,
SENSORCAINE/EPI 0.25,6065130,CDM,636,RC,J0665,HCPCS,Outpatient,,,40.5,32.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,80,,25.92,percent of total billed charges,80% of total billed charges,15.09,37.27,,12.07,percent of total billed charges,37.27% of total billed charges,15.09,37.27,,12.07,percent of total billed charges,37.27% of total billed charges,15.09,37.27,,12.07,percent of total billed charges,37.27% of total billed charges,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.2,40,,12.96,percent of total billed charges,40% of total billed charges,0.01,32.4,
AMPICILLIN 500MG CAP,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
METHYLPREDNISOLONE 4,6400014,CDM,250,RC,,,Outpatient,,,14.55,11.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.64,80,,9.31,percent of total billed charges,80% of total billed charges,5.42,37.27,,4.34,percent of total billed charges,37.27% of total billed charges,5.42,37.27,,4.34,percent of total billed charges,37.27% of total billed charges,5.42,37.27,,4.34,percent of total billed charges,37.27% 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,5.82,40,,4.66,percent of total billed charges,40% of total billed charges,5.42,11.64,
PILOCARPINE 4% EYE D,6400014,CDM,250,RC,,,Outpatient,,,89.7,71.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.76,80,,57.41,percent of total billed charges,80% of total billed charges,33.43,37.27,,26.74,percent of total billed charges,37.27% of total billed charges,33.43,37.27,,26.74,percent of total billed charges,37.27% of total billed charges,33.43,37.27,,26.74,percent of total billed charges,37.27% 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,35.88,40,,28.7,percent of total billed charges,40% of total billed charges,33.43,71.76,
NEO/POLY/HC EAR SUSP,6400014,CDM,250,RC,,,Outpatient,,,262.75,210.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.2,80,,168.16,percent of total billed charges,80% of total billed charges,97.93,37.27,,78.34,percent of total billed charges,37.27% of total billed charges,97.93,37.27,,78.34,percent of total billed charges,37.27% of total billed charges,97.93,37.27,,78.34,percent of total billed charges,37.27% 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,105.1,40,,84.08,percent of total billed charges,40% of total billed charges,97.93,210.2,
NORTRIPTYLINE HCL 50,6400014,CDM,250,RC,,,Outpatient,,,4.98,3.98,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.98,80,,3.18,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,1.99,40,,1.59,percent of total billed charges,40% of total billed charges,1.86,3.98,
PHENYLEPHRINE 10MG/M,6065130,CDM,636,RC,J2371,HCPCS,Outpatient,,,13.85,11.08,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.08,80,,8.86,percent of total billed charges,80% of total billed charges,5.16,37.27,,4.13,percent of total billed charges,37.27% of total billed charges,5.16,37.27,,4.13,percent of total billed charges,37.27% of total billed charges,5.16,37.27,,4.13,percent of total billed charges,37.27% 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,5.54,40,,4.43,percent of total billed charges,40% of total billed charges,5.16,11.08,
PREDNISONE 5MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
SPORANOX 100MG CAP U,6400014,CDM,250,RC,,,Outpatient,,,132.05,105.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.64,80,,84.51,percent of total billed charges,80% of total billed charges,49.22,37.27,,39.38,percent of total billed charges,37.27% of total billed charges,49.22,37.27,,39.38,percent of total billed charges,37.27% of total billed charges,49.22,37.27,,39.38,percent of total billed charges,37.27% 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,52.82,40,,42.26,percent of total billed charges,40% of total billed charges,49.22,105.64,
SEROQUEL 100MG TAB,6400014,CDM,250,RC,,,Outpatient,,,7.19,5.75,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.75,80,,4.6,percent of total billed charges,80% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% 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,2.88,40,,2.3,percent of total billed charges,40% of total billed charges,2.68,5.75,
SEROQUEL 200MG TAB,6400014,CDM,250,RC,,,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% 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,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,18.26,39.2,
SEROQUEL 25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,15.15,12.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.12,80,,9.7,percent of total billed charges,80% of total billed charges,5.65,37.27,,4.52,percent of total billed charges,37.27% of total billed charges,5.65,37.27,,4.52,percent of total billed charges,37.27% of total billed charges,5.65,37.27,,4.52,percent of total billed charges,37.27% 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,6.06,40,,4.85,percent of total billed charges,40% of total billed charges,5.65,12.12,
QUINIDINE SULF 200MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
QUININE SULFATE 260M,6400014,CDM,250,RC,,,Outpatient,,,2.7,2.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,80,,1.73,percent of total billed charges,80% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% 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,1.08,40,,0.86,percent of total billed charges,40% of total billed charges,1.01,2.16,
ALTACE 5MG CAP UD,6400014,CDM,250,RC,,,Outpatient,,,7.75,6.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.2,80,,4.96,percent of total billed charges,80% of total billed charges,2.89,37.27,,2.31,percent of total billed charges,37.27% of total billed charges,2.89,37.27,,2.31,percent of total billed charges,37.27% of total billed charges,2.89,37.27,,2.31,percent of total billed charges,37.27% 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,3.1,40,,2.48,percent of total billed charges,40% of total billed charges,2.89,6.2,
RESERPINE 0.25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
PROPRANOLOL 80MG CAP,6400014,CDM,250,RC,,,Outpatient,,,2.64,2.11,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.11,80,,1.69,percent of total billed charges,80% of total billed charges,0.98,37.27,,0.78,percent of total billed charges,37.27% of total billed charges,0.98,37.27,,0.78,percent of total billed charges,37.27% of total billed charges,0.98,37.27,,0.78,percent of total billed charges,37.27% 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,1.06,40,,0.85,percent of total billed charges,40% of total billed charges,0.98,2.11,
PSEUDOEPHEDRINE 30MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
TYLENOL SINUS CAP,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
PROPRANOLOL 60MG CAP,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
PROMETHAZINE 25MG/ML,6065130,CDM,636,RC,J2550,HCPCS,Outpatient,,,140.25,112.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.2,80,,89.76,percent of total billed charges,80% of total billed charges,52.27,37.27,,41.82,percent of total billed charges,37.27% of total billed charges,52.27,37.27,,41.82,percent of total billed charges,37.27% of total billed charges,52.27,37.27,,41.82,percent of total billed charges,37.27% 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,56.1,40,,44.88,percent of total billed charges,40% of total billed charges,52.27,112.2,
PROMETHAZINE 6.25MG/,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
PROMETHEGAN 50MG SUP,6400014,CDM,250,RC,,,Outpatient,,,111.2,88.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.96,80,,71.17,percent of total billed charges,80% of total billed charges,41.44,37.27,,33.15,percent of total billed charges,37.27% of total billed charges,41.44,37.27,,33.15,percent of total billed charges,37.27% of total billed charges,41.44,37.27,,33.15,percent of total billed charges,37.27% 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,44.48,40,,35.58,percent of total billed charges,40% of total billed charges,41.44,88.96,
PROPACET 100-650 TAB,6400014,CDM,250,RC,,,Outpatient,,,2.25,1.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,80,,1.44,percent of total billed charges,80% of total billed charges,0.84,37.27,,0.67,percent of total billed charges,37.27% of total billed charges,0.84,37.27,,0.67,percent of total billed charges,37.27% of total billed charges,0.84,37.27,,0.67,percent of total billed charges,37.27% 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,0.9,40,,0.72,percent of total billed charges,40% of total billed charges,0.84,1.8,
PRIMIDONE 250MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.35,2.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.68,80,,2.14,percent of total billed charges,80% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% 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,1.34,40,,1.07,percent of total billed charges,40% of total billed charges,1.25,2.68,
PROBENECID/COLCHICIN,6400014,CDM,250,RC,,,Outpatient,,,3.25,2.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.6,80,,2.08,percent of total billed charges,80% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% 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,1.3,40,,1.04,percent of total billed charges,40% of total billed charges,1.21,2.6,
PIROXICAM 10MG CAP,6400014,CDM,250,RC,,,Outpatient,,,4.75,3.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.8,80,,3.04,percent of total billed charges,80% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% 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,1.9,40,,1.52,percent of total billed charges,40% of total billed charges,1.77,3.8,
POT. PHOSPHATE 3MM/M,6400014,CDM,250,RC,,,Outpatient,,,275.25,220.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.2,80,,176.16,percent of total billed charges,80% of total billed charges,102.59,37.27,,82.07,percent of total billed charges,37.27% of total billed charges,102.59,37.27,,82.07,percent of total billed charges,37.27% of total billed charges,102.59,37.27,,82.07,percent of total billed charges,37.27% 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,110.1,40,,88.08,percent of total billed charges,40% of total billed charges,102.59,220.2,
PREDNISONE 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PREDNISONE 1MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PREDNISONE 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PILOCARPINE 2% EYE D,6400014,CDM,250,RC,,,Outpatient,,,85.45,68.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.36,80,,54.69,percent of total billed charges,80% of total billed charges,31.85,37.27,,25.48,percent of total billed charges,37.27% of total billed charges,31.85,37.27,,25.48,percent of total billed charges,37.27% of total billed charges,31.85,37.27,,25.48,percent of total billed charges,37.27% 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,34.18,40,,27.34,percent of total billed charges,40% of total billed charges,31.85,68.36,
PHENYTOIN 50MG/ML VI,6065130,CDM,636,RC,J1165,HCPCS,Outpatient,,,13.05,10.44,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.44,80,,8.35,percent of total billed charges,80% of total billed charges,4.86,37.27,,3.89,percent of total billed charges,37.27% of total billed charges,4.86,37.27,,3.89,percent of total billed charges,37.27% of total billed charges,4.86,37.27,,3.89,percent of total billed charges,37.27% 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,5.22,40,,4.18,percent of total billed charges,40% of total billed charges,4.86,10.44,
PILOCAR 6% EYE DROPS,6400014,CDM,250,RC,,,Outpatient,,,43.35,34.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.68,80,,27.74,percent of total billed charges,80% of total billed charges,16.16,37.27,,12.93,percent of total billed charges,37.27% of total billed charges,16.16,37.27,,12.93,percent of total billed charges,37.27% of total billed charges,16.16,37.27,,12.93,percent of total billed charges,37.27% 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,17.34,40,,13.87,percent of total billed charges,40% of total billed charges,16.16,34.68,
RHINALL 0.25% NOSE S,6400014,CDM,250,RC,,,Outpatient,,,26.45,21.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.16,80,,16.93,percent of total billed charges,80% of total billed charges,9.86,37.27,,7.89,percent of total billed charges,37.27% of total billed charges,9.86,37.27,,7.89,percent of total billed charges,37.27% of total billed charges,9.86,37.27,,7.89,percent of total billed charges,37.27% 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,10.58,40,,8.46,percent of total billed charges,40% of total billed charges,9.86,21.16,
PENICILLIN VK 125MG/,6400014,CDM,250,RC,,,Outpatient,,,35.8,28.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.64,80,,22.91,percent of total billed charges,80% of total billed charges,13.34,37.27,,10.67,percent of total billed charges,37.27% of total billed charges,13.34,37.27,,10.67,percent of total billed charges,37.27% of total billed charges,13.34,37.27,,10.67,percent of total billed charges,37.27% 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,14.32,40,,11.46,percent of total billed charges,40% of total billed charges,13.34,28.64,
PENICILLIN VK 250MG/,6400014,CDM,250,RC,,,Outpatient,,,29,23.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% 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,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,10.81,23.2,
NYSTATIN 100000U/ML,6400014,CDM,250,RC,,,Outpatient,,,60.95,48.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.76,80,,39.01,percent of total billed charges,80% of total billed charges,22.72,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.72,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.72,37.27,,18.18,percent of total billed charges,37.27% 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,24.38,40,,19.5,percent of total billed charges,40% of total billed charges,22.72,48.76,
"NYSTOP 100,000U/GM P",6400014,CDM,250,RC,,,Outpatient,,,59.55,47.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.64,80,,38.11,percent of total billed charges,80% of total billed charges,22.19,37.27,,17.75,percent of total billed charges,37.27% of total billed charges,22.19,37.27,,17.75,percent of total billed charges,37.27% of total billed charges,22.19,37.27,,17.75,percent of total billed charges,37.27% 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,23.82,40,,19.06,percent of total billed charges,40% of total billed charges,22.19,47.64,
NICODERM CQ 21MG/24H,6400014,CDM,250,RC,,,Outpatient,,,8.65,6.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.92,80,,5.54,percent of total billed charges,80% of total billed charges,3.22,37.27,,2.58,percent of total billed charges,37.27% of total billed charges,3.22,37.27,,2.58,percent of total billed charges,37.27% of total billed charges,3.22,37.27,,2.58,percent of total billed charges,37.27% 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,3.46,40,,2.77,percent of total billed charges,40% of total billed charges,3.22,6.92,
NICODERM CQ 7MG/24HR,6400014,CDM,250,RC,,,Outpatient,,,8.65,6.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.92,80,,5.54,percent of total billed charges,80% of total billed charges,3.22,37.27,,2.58,percent of total billed charges,37.27% of total billed charges,3.22,37.27,,2.58,percent of total billed charges,37.27% of total billed charges,3.22,37.27,,2.58,percent of total billed charges,37.27% 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,3.46,40,,2.77,percent of total billed charges,40% of total billed charges,3.22,6.92,
SULAR 10MG TAB SA,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
NITROFURANTOIN MCR 1,6400014,CDM,250,RC,,,Outpatient,,,3.7,2.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.96,80,,2.37,percent of total billed charges,80% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% 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,1.48,40,,1.18,percent of total billed charges,40% of total billed charges,1.38,2.96,
NITROGLYCERIN .2MG/H,6400014,CDM,250,RC,,,Outpatient,,,6.45,5.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.16,80,,4.13,percent of total billed charges,80% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% 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,2.58,40,,2.06,percent of total billed charges,40% of total billed charges,2.4,5.16,
NITROGLYCERIN .4MG/H,6400014,CDM,250,RC,,,Outpatient,,,7.4,5.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.92,80,,4.74,percent of total billed charges,80% of total billed charges,2.76,37.27,,2.21,percent of total billed charges,37.27% of total billed charges,2.76,37.27,,2.21,percent of total billed charges,37.27% of total billed charges,2.76,37.27,,2.21,percent of total billed charges,37.27% 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,2.96,40,,2.37,percent of total billed charges,40% of total billed charges,2.76,5.92,
NITROGLYCERIN 5MG/ML,6065130,CDM,636,RC,J2305,HCPCS,Outpatient,,,46.8,37.44,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,80,,29.95,percent of total billed charges,80% of total billed charges,17.44,37.27,,13.95,percent of total billed charges,37.27% of total billed charges,17.44,37.27,,13.95,percent of total billed charges,37.27% of total billed charges,17.44,37.27,,13.95,percent of total billed charges,37.27% of total billed charges,1.41,100,,,fee schedule,100% of APC rate,1.41,100,,,fee schedule,100% of APC rate,1.41,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1.41,100,,,fee schedule,100% of APC rate,1.41,100,,,fee schedule,100% of APC rate,1.41,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.72,40,,14.98,percent of total billed charges,40% of total billed charges,1.41,37.44,
TRIPLE ANTIBIOTIC EY,6400014,CDM,250,RC,,,Outpatient,,,182.8,146.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.24,80,,116.99,percent of total billed charges,80% of total billed charges,68.13,37.27,,54.5,percent of total billed charges,37.27% of total billed charges,68.13,37.27,,54.5,percent of total billed charges,37.27% of total billed charges,68.13,37.27,,54.5,percent of total billed charges,37.27% 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,73.12,40,,58.5,percent of total billed charges,40% of total billed charges,68.13,146.24,
THERAPEUTIC VIT/MIN,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
THERAPEUTIC-M TAB UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
STRESS TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
THERAPEUTIC-H TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
NEUTRA-PHOS POWDER,6400014,CDM,250,RC,,,Outpatient,,,2.2,1.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,80,,1.41,percent of total billed charges,80% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% 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,0.88,40,,0.7,percent of total billed charges,40% of total billed charges,0.82,1.76,
NADOLOL 40MG TAB,6400014,CDM,250,RC,,,Outpatient,,,24.65,19.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.72,80,,15.78,percent of total billed charges,80% of total billed charges,9.19,37.27,,7.35,percent of total billed charges,37.27% of total billed charges,9.19,37.27,,7.35,percent of total billed charges,37.27% of total billed charges,9.19,37.27,,7.35,percent of total billed charges,37.27% 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,9.86,40,,7.89,percent of total billed charges,40% of total billed charges,9.19,19.72,
NALBUPHINE 10MG/ML A,6065130,CDM,636,RC,J2300,HCPCS,Outpatient,,,16,12.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% 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,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,5.96,12.8,
NASAREL NASAL SOLN,6400014,CDM,250,RC,,,Outpatient,,,152.65,122.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.12,80,,97.7,percent of total billed charges,80% of total billed charges,56.89,37.27,,45.51,percent of total billed charges,37.27% of total billed charges,56.89,37.27,,45.51,percent of total billed charges,37.27% of total billed charges,56.89,37.27,,45.51,percent of total billed charges,37.27% 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,61.06,40,,48.85,percent of total billed charges,40% of total billed charges,56.89,122.12,
NALOXONE 0.4MG/ML AM,6065130,CDM,636,RC,J2310,HCPCS,Outpatient,,,27.9,22.32,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.32,80,,17.86,percent of total billed charges,80% of total billed charges,10.4,37.27,,8.32,percent of total billed charges,37.27% of total billed charges,10.4,37.27,,8.32,percent of total billed charges,37.27% of total billed charges,10.4,37.27,,8.32,percent of total billed charges,37.27% 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,11.16,40,,8.93,percent of total billed charges,40% of total billed charges,10.4,22.32,
PREVACID 15 MG CAPSU,6400014,CDM,250,RC,,,Outpatient,,,20.6,16.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.48,80,,13.18,percent of total billed charges,80% of total billed charges,7.68,37.27,,6.14,percent of total billed charges,37.27% of total billed charges,7.68,37.27,,6.14,percent of total billed charges,37.27% of total billed charges,7.68,37.27,,6.14,percent of total billed charges,37.27% 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,8.24,40,,6.59,percent of total billed charges,40% of total billed charges,7.68,16.48,
NAPROXEN SODIUM 550M,6400014,CDM,250,RC,,,Outpatient,,,4.7,3.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.76,80,,3.01,percent of total billed charges,80% of total billed charges,1.75,37.27,,1.4,percent of total billed charges,37.27% of total billed charges,1.75,37.27,,1.4,percent of total billed charges,37.27% of total billed charges,1.75,37.27,,1.4,percent of total billed charges,37.27% 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,1.88,40,,1.5,percent of total billed charges,40% of total billed charges,1.75,3.76,
SERZONE 100MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,3.34,2.67,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.67,80,,2.14,percent of total billed charges,80% of total billed charges,1.24,37.27,,0.99,percent of total billed charges,37.27% of total billed charges,1.24,37.27,,0.99,percent of total billed charges,37.27% of total billed charges,1.24,37.27,,0.99,percent of total billed charges,37.27% 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,1.34,40,,1.07,percent of total billed charges,40% of total billed charges,1.24,2.67,
XANAX 0.25MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,2.5,2.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
ACETAMINOPHEN SUPP.,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
ACETAMINOPHEN SUPP.,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
FLEXTRA-DS TABLET,6400014,CDM,250,RC,,,Outpatient,,,2.05,1.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.64,80,,1.31,percent of total billed charges,80% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% 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,0.82,40,,0.66,percent of total billed charges,40% of total billed charges,0.76,1.64,
SERZONE 150MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,3.34,2.67,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.67,80,,2.14,percent of total billed charges,80% of total billed charges,1.24,37.27,,0.99,percent of total billed charges,37.27% of total billed charges,1.24,37.27,,0.99,percent of total billed charges,37.27% of total billed charges,1.24,37.27,,0.99,percent of total billed charges,37.27% 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,1.34,40,,1.07,percent of total billed charges,40% of total billed charges,1.24,2.67,
TRIPLE ANTIBIOTIC OI,6400014,CDM,250,RC,,,Outpatient,,,25.3,20.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.24,80,,16.19,percent of total billed charges,80% of total billed charges,9.43,37.27,,7.54,percent of total billed charges,37.27% of total billed charges,9.43,37.27,,7.54,percent of total billed charges,37.27% of total billed charges,9.43,37.27,,7.54,percent of total billed charges,37.27% 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,10.12,40,,8.1,percent of total billed charges,40% of total billed charges,9.43,20.24,
NEO/POLY/HC EAR SOLN,6400014,CDM,250,RC,,,Outpatient,,,304.15,243.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.32,80,,194.66,percent of total billed charges,80% of total billed charges,113.36,37.27,,90.69,percent of total billed charges,37.27% of total billed charges,113.36,37.27,,90.69,percent of total billed charges,37.27% of total billed charges,113.36,37.27,,90.69,percent of total billed charges,37.27% 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,121.66,40,,97.33,percent of total billed charges,40% of total billed charges,113.36,243.32,
MULTIVITAMIN TAB (S/,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
TRI-TANNATE SUSPENSI,6400014,CDM,250,RC,,,Outpatient,,,6.84,5.47,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.47,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.47,
MINOXIDIL 2.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.95,1.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.56,80,,1.25,percent of total billed charges,80% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% 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,0.78,40,,0.62,percent of total billed charges,40% of total billed charges,0.73,1.56,
MINOXIDIL 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,4.4,3.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.52,80,,2.82,percent of total billed charges,80% of total billed charges,1.64,37.27,,1.31,percent of total billed charges,37.27% of total billed charges,1.64,37.27,,1.31,percent of total billed charges,37.27% of total billed charges,1.64,37.27,,1.31,percent of total billed charges,37.27% 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,1.76,40,,1.41,percent of total billed charges,40% of total billed charges,1.64,3.52,
MICONAZOLE NITRATE 2,6400014,CDM,250,RC,,,Outpatient,,,9.9,7.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.92,80,,6.34,percent of total billed charges,80% of total billed charges,3.69,37.27,,2.95,percent of total billed charges,37.27% of total billed charges,3.69,37.27,,2.95,percent of total billed charges,37.27% of total billed charges,3.69,37.27,,2.95,percent of total billed charges,37.27% 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,3.96,40,,3.17,percent of total billed charges,40% of total billed charges,3.69,7.92,
MINERAL OIL HEAVY,6400014,CDM,250,RC,,,Outpatient,,,23.3,18.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.64,80,,14.91,percent of total billed charges,80% of total billed charges,8.68,37.27,,6.94,percent of total billed charges,37.27% of total billed charges,8.68,37.27,,6.94,percent of total billed charges,37.27% of total billed charges,8.68,37.27,,6.94,percent of total billed charges,37.27% 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,9.32,40,,7.46,percent of total billed charges,40% of total billed charges,8.68,18.64,
METHENAMINE MAND 500,6400014,CDM,250,RC,,,Outpatient,,,2.15,1.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.72,80,,1.38,percent of total billed charges,80% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% 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,0.86,40,,0.69,percent of total billed charges,40% of total billed charges,0.8,1.72,
METHADONE HCL 5MG TA,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
PENTOXIFYLLINE 400MG,6400014,CDM,250,RC,,,Outpatient,,,5.1,4.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.08,80,,3.26,percent of total billed charges,80% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% 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,2.04,40,,1.63,percent of total billed charges,40% of total billed charges,1.9,4.08,
THIORIDAZINE 100MG T,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
VITAMIN B1 100MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
THEOPHYLLINE 80MG/15,6400014,CDM,250,RC,,,Outpatient,,,8.7,6.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.96,80,,5.57,percent of total billed charges,80% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% 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,3.48,40,,2.78,percent of total billed charges,40% of total billed charges,3.24,6.96,
THEOPHYLLINE 300MG C,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
THEOPHYLLINE 200MG C,6400014,CDM,250,RC,,,Outpatient,,,2.45,1.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.96,80,,1.57,percent of total billed charges,80% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% 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,0.98,40,,0.78,percent of total billed charges,40% of total billed charges,0.91,1.96,
TEMAZEPAM 7.5MG CAP,6400014,CDM,250,RC,,,Outpatient,,,41.1,32.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.88,80,,26.3,percent of total billed charges,80% of total billed charges,15.32,37.27,,12.26,percent of total billed charges,37.27% of total billed charges,15.32,37.27,,12.26,percent of total billed charges,37.27% of total billed charges,15.32,37.27,,12.26,percent of total billed charges,37.27% 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,16.44,40,,13.15,percent of total billed charges,40% of total billed charges,15.32,32.88,
SULINDAC 150MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.35,2.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.68,80,,2.14,percent of total billed charges,80% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% 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,1.34,40,,1.07,percent of total billed charges,40% of total billed charges,1.25,2.68,
SUCRALFATE 1GM TAB,6400014,CDM,250,RC,,,Outpatient,,,2.7,2.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,80,,1.73,percent of total billed charges,80% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% 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,1.08,40,,0.86,percent of total billed charges,40% of total billed charges,1.01,2.16,
STERILE WATER IR BAG,5645742,CDM,270,RC,,,Outpatient,,,40.2,32.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.16,80,,25.73,percent of total billed charges,80% of total billed charges,14.98,37.27,,11.98,percent of total billed charges,37.27% of total billed charges,14.98,37.27,,11.98,percent of total billed charges,37.27% of total billed charges,14.98,37.27,,11.98,percent of total billed charges,37.27% 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,16.08,40,,12.86,percent of total billed charges,40% of total billed charges,14.98,32.16,
SOD CIT/CITRIC ACID,6400014,CDM,250,RC,,,Outpatient,,,17.4,13.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.92,80,,11.14,percent of total billed charges,80% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% 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,6.96,40,,5.57,percent of total billed charges,40% of total billed charges,6.48,13.92,
SODIUM CHLORIDE 0.9%,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
SALINEX 0.4% NOSE DR,6400014,CDM,250,RC,,,Outpatient,,,13.89,11.11,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.11,80,,8.89,percent of total billed charges,80% of total billed charges,5.18,37.27,,4.14,percent of total billed charges,37.27% of total billed charges,5.18,37.27,,4.14,percent of total billed charges,37.27% of total billed charges,5.18,37.27,,4.14,percent of total billed charges,37.27% 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,5.56,40,,4.45,percent of total billed charges,40% of total billed charges,5.18,11.11,
SODIUM BICARB 8.4% V,6400014,CDM,250,RC,,,Outpatient,,,24.75,19.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.8,80,,15.84,percent of total billed charges,80% of total billed charges,9.22,37.27,,7.38,percent of total billed charges,37.27% of total billed charges,9.22,37.27,,7.38,percent of total billed charges,37.27% of total billed charges,9.22,37.27,,7.38,percent of total billed charges,37.27% 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,9.9,40,,7.92,percent of total billed charges,40% of total billed charges,9.22,19.8,
COLYTE FLAVORED SOLU,6400014,CDM,250,RC,,,Outpatient,,,14.32,11.46,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.46,80,,9.17,percent of total billed charges,80% of total billed charges,5.34,37.27,,4.27,percent of total billed charges,37.27% of total billed charges,5.34,37.27,,4.27,percent of total billed charges,37.27% of total billed charges,5.34,37.27,,4.27,percent of total billed charges,37.27% 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,5.73,40,,4.58,percent of total billed charges,40% of total billed charges,5.34,11.46,
CLARITIN-D 12 HOUR T,6400014,CDM,250,RC,,,Outpatient,,,2.3,1.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.84,80,,1.47,percent of total billed charges,80% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% 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,0.92,40,,0.74,percent of total billed charges,40% of total billed charges,0.86,1.84,
SIMPLE SYRUP,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
SIMETHICONE 80MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
SIMETHICONE 125MG TA,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
THERMAZENE 1% CREAM,6400014,CDM,250,RC,,,Outpatient,,,107.5,86.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86,80,,68.8,percent of total billed charges,80% of total billed charges,40.07,37.27,,32.06,percent of total billed charges,37.27% of total billed charges,40.07,37.27,,32.06,percent of total billed charges,37.27% of total billed charges,40.07,37.27,,32.06,percent of total billed charges,37.27% 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,43,40,,34.4,percent of total billed charges,40% of total billed charges,40.07,86,
SELSUN BLUE SHAMPOO,5828504,CDM,990,RC,,,Outpatient,,,26.95,21.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.56,80,,17.25,percent of total billed charges,80% of total billed charges,10.04,37.27,,8.03,percent of total billed charges,37.27% of total billed charges,10.04,37.27,,8.03,percent of total billed charges,37.27% of total billed charges,10.04,37.27,,8.03,percent of total billed charges,37.27% 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,10.78,40,,8.62,percent of total billed charges,40% of total billed charges,10.04,21.56,
SELEGILINE HCL 5MG T,6400014,CDM,250,RC,,,Outpatient,,,10.1,8.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.08,80,,6.46,percent of total billed charges,80% of total billed charges,3.76,37.27,,3.01,percent of total billed charges,37.27% of total billed charges,3.76,37.27,,3.01,percent of total billed charges,37.27% of total billed charges,3.76,37.27,,3.01,percent of total billed charges,37.27% 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,4.04,40,,3.23,percent of total billed charges,40% of total billed charges,3.76,8.08,
LUBRI-SOFT LOTION,6400014,CDM,250,RC,,,Outpatient,,,6.86,5.49,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.49,80,,4.39,percent of total billed charges,80% of total billed charges,2.56,37.27,,2.05,percent of total billed charges,37.27% of total billed charges,2.56,37.27,,2.05,percent of total billed charges,37.27% of total billed charges,2.56,37.27,,2.05,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.56,5.49,
PANRITIS FORTE 600MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
RESPERDAL 1MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,21.95,17.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.56,80,,14.05,percent of total billed charges,80% of total billed charges,8.18,37.27,,6.54,percent of total billed charges,37.27% of total billed charges,8.18,37.27,,6.54,percent of total billed charges,37.27% of total billed charges,8.18,37.27,,6.54,percent of total billed charges,37.27% 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,8.78,40,,7.02,percent of total billed charges,40% of total billed charges,8.18,17.56,
TRIAMCINOLONE 0.1% P,6400014,CDM,250,RC,,,Outpatient,,,234.5,187.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.6,80,,150.08,percent of total billed charges,80% of total billed charges,87.4,37.27,,69.92,percent of total billed charges,37.27% of total billed charges,87.4,37.27,,69.92,percent of total billed charges,37.27% of total billed charges,87.4,37.27,,69.92,percent of total billed charges,37.27% 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,93.8,40,,75.04,percent of total billed charges,40% of total billed charges,87.4,187.6,
TRIAMCINOLONE 0.1% O,6400014,CDM,250,RC,,,Outpatient,,,64.01,51.21,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.21,80,,40.97,percent of total billed charges,80% of total billed charges,23.86,37.27,,19.09,percent of total billed charges,37.27% of total billed charges,23.86,37.27,,19.09,percent of total billed charges,37.27% of total billed charges,23.86,37.27,,19.09,percent of total billed charges,37.27% 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,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,23.86,51.21,
TRIAMCINOLONE 0.1% O,6400014,CDM,250,RC,,,Outpatient,,,6.57,5.26,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.26,80,,4.21,percent of total billed charges,80% of total billed charges,2.45,37.27,,1.96,percent of total billed charges,37.27% of total billed charges,2.45,37.27,,1.96,percent of total billed charges,37.27% of total billed charges,2.45,37.27,,1.96,percent of total billed charges,37.27% 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,2.63,40,,2.1,percent of total billed charges,40% of total billed charges,2.45,5.26,
TRIACMINOLONE 0.1% L,6400014,CDM,250,RC,,,Outpatient,,,32.82,26.26,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.26,80,,21.01,percent of total billed charges,80% of total billed charges,12.23,37.27,,9.78,percent of total billed charges,37.27% of total billed charges,12.23,37.27,,9.78,percent of total billed charges,37.27% of total billed charges,12.23,37.27,,9.78,percent of total billed charges,37.27% 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,13.13,40,,10.5,percent of total billed charges,40% of total billed charges,12.23,26.26,
TRIAMCINOLONE 0.1% C,6400014,CDM,250,RC,,,Outpatient,,,18.24,14.59,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.59,80,,11.67,percent of total billed charges,80% of total billed charges,6.8,37.27,,5.44,percent of total billed charges,37.27% of total billed charges,6.8,37.27,,5.44,percent of total billed charges,37.27% of total billed charges,6.8,37.27,,5.44,percent of total billed charges,37.27% 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,7.3,40,,5.84,percent of total billed charges,40% of total billed charges,6.8,14.59,
TRIAMCINOLONE 0.1% C,6400014,CDM,250,RC,,,Outpatient,,,6.47,5.18,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.18,80,,4.14,percent of total billed charges,80% of total billed charges,2.41,37.27,,1.93,percent of total billed charges,37.27% of total billed charges,2.41,37.27,,1.93,percent of total billed charges,37.27% of total billed charges,2.41,37.27,,1.93,percent of total billed charges,37.27% 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,2.59,40,,2.07,percent of total billed charges,40% of total billed charges,2.41,5.18,
SANDOSTATIN 0.05MG/M,6065130,CDM,636,RC,J2354,HCPCS,Outpatient,,,40.95,32.76,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.76,80,,26.21,percent of total billed charges,80% of total billed charges,15.26,37.27,,12.21,percent of total billed charges,37.27% of total billed charges,15.26,37.27,,12.21,percent of total billed charges,37.27% of total billed charges,15.26,37.27,,12.21,percent of total billed charges,37.27% 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,16.38,40,,13.1,percent of total billed charges,40% of total billed charges,15.26,32.76,
M.T.E.-4 VIAL,6400014,CDM,250,RC,,,Outpatient,,,146.1,116.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.88,80,,93.5,percent of total billed charges,80% of total billed charges,54.45,37.27,,43.56,percent of total billed charges,37.27% of total billed charges,54.45,37.27,,43.56,percent of total billed charges,37.27% of total billed charges,54.45,37.27,,43.56,percent of total billed charges,37.27% 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,58.44,40,,46.75,percent of total billed charges,40% of total billed charges,54.45,116.88,
THIORIDAZINE 25MG TA,6400014,CDM,250,RC,,,Outpatient,,,2.6,2.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.08,80,,1.66,percent of total billed charges,80% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% 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,1.04,40,,0.83,percent of total billed charges,40% of total billed charges,0.97,2.08,
WATER FOR INJECT FLI,5645742,CDM,270,RC,,,Outpatient,,,4.55,3.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.64,80,,2.91,percent of total billed charges,80% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% 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,1.82,40,,1.46,percent of total billed charges,40% of total billed charges,1.7,3.64,
COUMADIN 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.67,2.14,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.14,80,,1.71,percent of total billed charges,80% of total billed charges,1,37.27,,0.8,percent of total billed charges,37.27% of total billed charges,1,37.27,,0.8,percent of total billed charges,37.27% of total billed charges,1,37.27,,0.8,percent of total billed charges,37.27% 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,1.07,40,,0.86,percent of total billed charges,40% of total billed charges,1,2.14,
VITAMIN B-COMPLEX W/,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
OXYCODONE/APAP 5/235,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
OXYBUTYNIN 5MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,2.1,1.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,80,,1.34,percent of total billed charges,80% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% 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,0.84,40,,0.67,percent of total billed charges,40% of total billed charges,0.78,1.68,
SPIRONOLACT/HCTZ 25/,6400014,CDM,250,RC,,,Outpatient,,,4.35,3.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.48,80,,2.78,percent of total billed charges,80% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% 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,1.74,40,,1.39,percent of total billed charges,40% of total billed charges,1.62,3.48,
SPIRONOLACT/HCTZ 25/,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
TRIAMTERENE/HCTZ 37.,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
TRIAMTERENE/HCTZ 37.,6400014,CDM,250,RC,,,Outpatient,,,3.35,2.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.68,80,,2.14,percent of total billed charges,80% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% 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,1.34,40,,1.07,percent of total billed charges,40% of total billed charges,1.25,2.68,
TRIMTERENE/HCTZ 75/5,6400014,CDM,250,RC,,,Outpatient,,,3.1,2.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.48,80,,1.98,percent of total billed charges,80% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% 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,1.24,40,,0.99,percent of total billed charges,40% of total billed charges,1.16,2.48,
HYDROCODONE/APAP 5/5,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
LORCET 10/650 TAB UD,6400014,CDM,250,RC,,,Outpatient,,,3.4,2.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.72,80,,2.18,percent of total billed charges,80% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% 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,1.36,40,,1.09,percent of total billed charges,40% of total billed charges,1.27,2.72,
LORCET PLUS TAB,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
PROCTOSOL-HC 2.5% CR,6400014,CDM,250,RC,,,Outpatient,,,51.91,41.53,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.53,80,,33.22,percent of total billed charges,80% of total billed charges,19.35,37.27,,15.48,percent of total billed charges,37.27% of total billed charges,19.35,37.27,,15.48,percent of total billed charges,37.27% of total billed charges,19.35,37.27,,15.48,percent of total billed charges,37.27% 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,20.76,40,,16.61,percent of total billed charges,40% of total billed charges,19.35,41.53,
NATURE'S TEARS DROPS,6400014,CDM,250,RC,,,Outpatient,,,0.9,0.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.72,80,,0.58,percent of total billed charges,80% of total billed charges,0.34,37.27,,0.27,percent of total billed charges,37.27% of total billed charges,0.34,37.27,,0.27,percent of total billed charges,37.27% of total billed charges,0.34,37.27,,0.27,percent of total billed charges,37.27% 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,0.36,40,,0.29,percent of total billed charges,40% of total billed charges,0.34,0.72,
TIAZAC 120MG CAP SA,6400014,CDM,250,RC,,,Outpatient,,,5.35,4.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.28,80,,3.42,percent of total billed charges,80% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% 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,2.14,40,,1.71,percent of total billed charges,40% of total billed charges,1.99,4.28,
OBNATE 90 TAB SA,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
LOVENOX 30MG PREFILE,6065130,CDM,636,RC,J1650,HCPCS,Outpatient,,,92.25,73.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.8,80,,59.04,percent of total billed charges,80% of total billed charges,34.38,37.27,,27.5,percent of total billed charges,37.27% of total billed charges,34.38,37.27,,27.5,percent of total billed charges,37.27% of total billed charges,34.38,37.27,,27.5,percent of total billed charges,37.27% 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,36.9,40,,29.52,percent of total billed charges,40% of total billed charges,34.38,73.8,
CHLORTHALIDONE 25MG,6400014,CDM,250,RC,,,Outpatient,,,7.8,6.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.24,80,,4.99,percent of total billed charges,80% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% 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,3.12,40,,2.5,percent of total billed charges,40% of total billed charges,2.91,6.24,
LODINE 300MG CAP UD,6400014,CDM,250,RC,,,Outpatient,,,4.79,3.83,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.83,80,,3.06,percent of total billed charges,80% of total billed charges,1.79,37.27,,1.43,percent of total billed charges,37.27% of total billed charges,1.79,37.27,,1.43,percent of total billed charges,37.27% of total billed charges,1.79,37.27,,1.43,percent of total billed charges,37.27% 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,1.92,40,,1.54,percent of total billed charges,40% of total billed charges,1.79,3.83,
CLINDAMYCIN HCL 150M,6400014,CDM,250,RC,,,Outpatient,,,4.5,3.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,80,,2.88,percent of total billed charges,80% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% 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,1.8,40,,1.44,percent of total billed charges,40% of total billed charges,1.68,3.6,
CLONAZEPAM 0.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.8,2.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,80,,1.79,percent of total billed charges,80% of total billed charges,1.04,37.27,,0.83,percent of total billed charges,37.27% of total billed charges,1.04,37.27,,0.83,percent of total billed charges,37.27% of total billed charges,1.04,37.27,,0.83,percent of total billed charges,37.27% 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,1.12,40,,0.9,percent of total billed charges,40% of total billed charges,1.04,2.24,
CLORAZEPATE 7.5MG TA,6400014,CDM,250,RC,,,Outpatient,,,10,8.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
CLORTRIMAZOLE 1% CRE,6400014,CDM,250,RC,,,Outpatient,,,67.95,54.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.36,80,,43.49,percent of total billed charges,80% of total billed charges,25.32,37.27,,20.26,percent of total billed charges,37.27% of total billed charges,25.32,37.27,,20.26,percent of total billed charges,37.27% of total billed charges,25.32,37.27,,20.26,percent of total billed charges,37.27% 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,27.18,40,,21.74,percent of total billed charges,40% of total billed charges,25.32,54.36,
LOTRIMIN 1% SOLUTION,6400014,CDM,250,RC,,,Outpatient,,,217.45,173.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.96,80,,139.17,percent of total billed charges,80% of total billed charges,81.04,37.27,,64.83,percent of total billed charges,37.27% of total billed charges,81.04,37.27,,64.83,percent of total billed charges,37.27% of total billed charges,81.04,37.27,,64.83,percent of total billed charges,37.27% 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,86.98,40,,69.58,percent of total billed charges,40% of total billed charges,81.04,173.96,
CLIDINIUM/CDP CAP,6400014,CDM,250,RC,,,Outpatient,,,17.5,14.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14,80,,11.2,percent of total billed charges,80% of total billed charges,6.52,37.27,,5.22,percent of total billed charges,37.27% of total billed charges,6.52,37.27,,5.22,percent of total billed charges,37.27% of total billed charges,6.52,37.27,,5.22,percent of total billed charges,37.27% 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,7,40,,5.6,percent of total billed charges,40% of total billed charges,6.52,14,
Q-TUSS TAB SA,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
METOPROLOL 1MG/ML AM,6400014,CDM,250,RC,,,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
METOPROLOL 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.15,1.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.72,80,,1.38,percent of total billed charges,80% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% 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,0.86,40,,0.69,percent of total billed charges,40% of total billed charges,0.8,1.72,
METOPROLOL 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
VERAPAMIL 240MG TAB,6400014,CDM,250,RC,,,Outpatient,,,8.6,6.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.88,80,,5.5,percent of total billed charges,80% of total billed charges,3.21,37.27,,2.57,percent of total billed charges,37.27% of total billed charges,3.21,37.27,,2.57,percent of total billed charges,37.27% of total billed charges,3.21,37.27,,2.57,percent of total billed charges,37.27% 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,3.44,40,,2.75,percent of total billed charges,40% of total billed charges,3.21,6.88,
TETRACAINE 0.5% EYE,6400014,CDM,250,RC,,,Outpatient,,,35.95,28.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.76,80,,23.01,percent of total billed charges,80% of total billed charges,13.4,37.27,,10.72,percent of total billed charges,37.27% of total billed charges,13.4,37.27,,10.72,percent of total billed charges,37.27% of total billed charges,13.4,37.27,,10.72,percent of total billed charges,37.27% 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,14.38,40,,11.5,percent of total billed charges,40% of total billed charges,13.4,28.76,
SULFATRIM SUSPENSION,6400014,CDM,250,RC,,,Outpatient,,,12.55,10.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.04,80,,8.03,percent of total billed charges,80% of total billed charges,4.68,37.27,,3.74,percent of total billed charges,37.27% of total billed charges,4.68,37.27,,3.74,percent of total billed charges,37.27% of total billed charges,4.68,37.27,,3.74,percent of total billed charges,37.27% 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,5.02,40,,4.02,percent of total billed charges,40% of total billed charges,4.68,10.04,
SALSALATE 500MG TABL,6400014,CDM,250,RC,,,Outpatient,,,2.3,1.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.84,80,,1.47,percent of total billed charges,80% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% 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,0.92,40,,0.74,percent of total billed charges,40% of total billed charges,0.86,1.84,
PROCAINAMIDE 500MG T,6400014,CDM,250,RC,,,Outpatient,,,2.7,2.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,80,,1.73,percent of total billed charges,80% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% 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,1.08,40,,0.86,percent of total billed charges,40% of total billed charges,1.01,2.16,
RANITIDINE 150MG TAB,6400014,CDM,250,RC,,,Outpatient,,,5.1,4.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.08,80,,3.26,percent of total billed charges,80% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% 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,2.04,40,,1.63,percent of total billed charges,40% of total billed charges,1.9,4.08,
VITAMIN C 500MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
RANITIDINE 150MG TAB,6400014,CDM,250,RC,,,Outpatient,,,4.88,3.90,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.9,80,,3.12,percent of total billed charges,80% of total billed charges,1.82,37.27,,1.46,percent of total billed charges,37.27% of total billed charges,1.82,37.27,,1.46,percent of total billed charges,37.27% of total billed charges,1.82,37.27,,1.46,percent of total billed charges,37.27% 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,1.95,40,,1.56,percent of total billed charges,40% of total billed charges,1.82,3.9,
CATAPRES TTS-1 PER P,6400014,CDM,250,RC,,,Outpatient,,,103.1,82.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.48,80,,65.98,percent of total billed charges,80% of total billed charges,38.43,37.27,,30.74,percent of total billed charges,37.27% of total billed charges,38.43,37.27,,30.74,percent of total billed charges,37.27% of total billed charges,38.43,37.27,,30.74,percent of total billed charges,37.27% 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,41.24,40,,32.99,percent of total billed charges,40% of total billed charges,38.43,82.48,
CATAPRES TTS-2 PER P,6400014,CDM,250,RC,,,Outpatient,,,162.45,129.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.96,80,,103.97,percent of total billed charges,80% of total billed charges,60.55,37.27,,48.44,percent of total billed charges,37.27% of total billed charges,60.55,37.27,,48.44,percent of total billed charges,37.27% of total billed charges,60.55,37.27,,48.44,percent of total billed charges,37.27% 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,64.98,40,,51.98,percent of total billed charges,40% of total billed charges,60.55,129.96,
PREDNISONE:20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ROCALTROL CAPS 0.25M,6400014,CDM,250,RC,,,Outpatient,,,6.95,5.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.56,80,,4.45,percent of total billed charges,80% of total billed charges,2.59,37.27,,2.07,percent of total billed charges,37.27% of total billed charges,2.59,37.27,,2.07,percent of total billed charges,37.27% of total billed charges,2.59,37.27,,2.07,percent of total billed charges,37.27% 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,2.78,40,,2.22,percent of total billed charges,40% of total billed charges,2.59,5.56,
SPIRONOLACTONE 25MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SENSORCAINE 0.25%/EP,6400014,CDM,250,RC,,,Outpatient,,,13.4,10.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.72,80,,8.58,percent of total billed charges,80% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% 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,5.36,40,,4.29,percent of total billed charges,40% of total billed charges,4.99,10.72,
TRIHEXPHENIDYL HCL 2,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
AZULFIDINE 500MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
VITAMIN B-12 TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
DIOVAN 80MG CAP,6400014,CDM,250,RC,,,Outpatient,,,3.76,3.01,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.01,80,,2.41,percent of total billed charges,80% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% 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,1.5,40,,1.2,percent of total billed charges,40% of total billed charges,1.4,3.01,
PROBENECID 500MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.35,2.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.68,80,,2.14,percent of total billed charges,80% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% 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,1.34,40,,1.07,percent of total billed charges,40% of total billed charges,1.25,2.68,
CALAN SR 240MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
CAPOTEN 12.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.9,1.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.52,80,,1.22,percent of total billed charges,80% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% 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,0.76,40,,0.61,percent of total billed charges,40% of total billed charges,0.71,1.52,
CAPOTEN 25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.1,1.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,80,,1.34,percent of total billed charges,80% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% 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,0.84,40,,0.67,percent of total billed charges,40% of total billed charges,0.78,1.68,
CLONIDINE 0.1MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CLONIDINE 0.3MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CORTISONE ACETATE 25,6400014,CDM,250,RC,,,Outpatient,,,2,1.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
COUMADIN TAB 2.5MG U,6400014,CDM,250,RC,,,Outpatient,,,9.05,7.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.24,80,,5.79,percent of total billed charges,80% of total billed charges,3.37,37.27,,2.7,percent of total billed charges,37.27% of total billed charges,3.37,37.27,,2.7,percent of total billed charges,37.27% of total billed charges,3.37,37.27,,2.7,percent of total billed charges,37.27% 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,3.62,40,,2.9,percent of total billed charges,40% of total billed charges,3.37,7.24,
DOCUSTAE SOD 100MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PROPOXYPHENE HCL 65M,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
DELTASONE 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
DYAZIDE CAP,6400014,CDM,250,RC,,,Outpatient,,,7.05,5.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.64,80,,4.51,percent of total billed charges,80% of total billed charges,2.63,37.27,,2.1,percent of total billed charges,37.27% of total billed charges,2.63,37.27,,2.1,percent of total billed charges,37.27% of total billed charges,2.63,37.27,,2.1,percent of total billed charges,37.27% 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,2.82,40,,2.26,percent of total billed charges,40% of total billed charges,2.63,5.64,
E.C. NAPROSYN 500 MG,6400014,CDM,250,RC,,,Outpatient,,,3.76,3.01,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.01,80,,2.41,percent of total billed charges,80% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% 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,1.5,40,,1.2,percent of total billed charges,40% of total billed charges,1.4,3.01,
ASPIRIN TAB 325MG UD,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
AMITRIPTYLINE 25MG,6400014,CDM,250,RC,,,Outpatient,,,2.15,1.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.72,80,,1.38,percent of total billed charges,80% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% 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,0.86,40,,0.69,percent of total billed charges,40% of total billed charges,0.8,1.72,
ESTRATEST HS TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
PULMICORT INHALER (B,6400014,CDM,250,RC,,,Outpatient,,,462,369.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,369.6,80,,295.68,percent of total billed charges,80% of total billed charges,172.19,37.27,,137.75,percent of total billed charges,37.27% of total billed charges,172.19,37.27,,137.75,percent of total billed charges,37.27% of total billed charges,172.19,37.27,,137.75,percent of total billed charges,37.27% 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,184.8,40,,147.84,percent of total billed charges,40% of total billed charges,172.19,369.6,
RETROVIR 300MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,16.7,13.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.36,80,,10.69,percent of total billed charges,80% of total billed charges,6.22,37.27,,4.98,percent of total billed charges,37.27% of total billed charges,6.22,37.27,,4.98,percent of total billed charges,37.27% of total billed charges,6.22,37.27,,4.98,percent of total billed charges,37.27% 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,6.68,40,,5.34,percent of total billed charges,40% of total billed charges,6.22,13.36,
LANOXIN 0.25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
FUROSEMIDE 40MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CHLORDIAZ,6400014,CDM,250,RC,,,Outpatient,,,2.45,1.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.96,80,,1.57,percent of total billed charges,80% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% 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,0.98,40,,0.78,percent of total billed charges,40% of total billed charges,0.91,1.96,
PENCILLIN V 500MG TA,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
PEPCID 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,5.2,4.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,80,,3.33,percent of total billed charges,80% of total billed charges,1.94,37.27,,1.55,percent of total billed charges,37.27% of total billed charges,1.94,37.27,,1.55,percent of total billed charges,37.27% of total billed charges,1.94,37.27,,1.55,percent of total billed charges,37.27% 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,2.08,40,,1.66,percent of total billed charges,40% of total billed charges,1.94,4.16,
PEPCID 40MG TAB,6400014,CDM,250,RC,,,Outpatient,,,9.3,7.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.44,80,,5.95,percent of total billed charges,80% of total billed charges,3.47,37.27,,2.78,percent of total billed charges,37.27% of total billed charges,3.47,37.27,,2.78,percent of total billed charges,37.27% of total billed charges,3.47,37.27,,2.78,percent of total billed charges,37.27% 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,3.72,40,,2.98,percent of total billed charges,40% of total billed charges,3.47,7.44,
DEXCHLORPHENIRAMINE,6400014,CDM,250,RC,,,Outpatient,,,2.05,1.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.64,80,,1.31,percent of total billed charges,80% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% 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,0.82,40,,0.66,percent of total billed charges,40% of total billed charges,0.76,1.64,
PHENAZOPYRIDINE 100M,6400014,CDM,250,RC,,,Outpatient,,,4.25,3.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.4,80,,2.72,percent of total billed charges,80% of total billed charges,1.58,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.58,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.58,37.27,,1.26,percent of total billed charges,37.27% 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,1.7,40,,1.36,percent of total billed charges,40% of total billed charges,1.58,3.4,
NEURONTIN 400MG CAPS,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
QUINIDINE 300MG SR,6400014,CDM,250,RC,,,Outpatient,,,3.6,2.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.88,80,,2.3,percent of total billed charges,80% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% of total billed charges,1.34,37.27,,1.07,percent of total billed charges,37.27% 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,1.44,40,,1.15,percent of total billed charges,40% of total billed charges,1.34,2.88,
SINGULAIR 5MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,10.33,8.26,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.26,80,,6.61,percent of total billed charges,80% of total billed charges,3.85,37.27,,3.08,percent of total billed charges,37.27% of total billed charges,3.85,37.27,,3.08,percent of total billed charges,37.27% of total billed charges,3.85,37.27,,3.08,percent of total billed charges,37.27% 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,4.13,40,,3.3,percent of total billed charges,40% of total billed charges,3.85,8.26,
VITAMIN B-6 100MG TA,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
B-D ORGINAL PEN NEED,6400014,CDM,250,RC,,,Outpatient,,,1.45,1.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.16,80,,0.93,percent of total billed charges,80% of total billed charges,0.54,37.27,,0.43,percent of total billed charges,37.27% of total billed charges,0.54,37.27,,0.43,percent of total billed charges,37.27% of total billed charges,0.54,37.27,,0.43,percent of total billed charges,37.27% 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,0.58,40,,0.46,percent of total billed charges,40% of total billed charges,0.54,1.16,
PSEUDOEPHEDRINE 30MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
CHLORPROMAZINE,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
CLORAZEPATE 7.5MG TA,6400014,CDM,250,RC,,,Outpatient,,,3.9,3.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.12,80,,2.5,percent of total billed charges,80% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% 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,1.56,40,,1.25,percent of total billed charges,40% of total billed charges,1.45,3.12,
GLYNASE 6MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.33,1.86,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.86,80,,1.49,percent of total billed charges,80% of total billed charges,0.87,37.27,,0.7,percent of total billed charges,37.27% of total billed charges,0.87,37.27,,0.7,percent of total billed charges,37.27% of total billed charges,0.87,37.27,,0.7,percent of total billed charges,37.27% 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,0.93,40,,0.74,percent of total billed charges,40% of total billed charges,0.87,1.86,
DIAZEPAM 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.9,1.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.52,80,,1.22,percent of total billed charges,80% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% 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,0.76,40,,0.61,percent of total billed charges,40% of total billed charges,0.71,1.52,
ZANTAC 150MG TAB,6400014,CDM,250,RC,,,Outpatient,,,5.95,4.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.76,80,,3.81,percent of total billed charges,80% of total billed charges,2.22,37.27,,1.78,percent of total billed charges,37.27% of total billed charges,2.22,37.27,,1.78,percent of total billed charges,37.27% of total billed charges,2.22,37.27,,1.78,percent of total billed charges,37.27% 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,2.38,40,,1.9,percent of total billed charges,40% of total billed charges,2.22,4.76,
VITAMIN A&D OINTMENT,6400014,CDM,250,RC,,,Outpatient,,,10.2,8.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.16,80,,6.53,percent of total billed charges,80% of total billed charges,3.8,37.27,,3.04,percent of total billed charges,37.27% of total billed charges,3.8,37.27,,3.04,percent of total billed charges,37.27% of total billed charges,3.8,37.27,,3.04,percent of total billed charges,37.27% 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,4.08,40,,3.26,percent of total billed charges,40% of total billed charges,3.8,8.16,
PREVACID 30MG CAPSUL,6400014,CDM,250,RC,,,Outpatient,,,20.6,16.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.48,80,,13.18,percent of total billed charges,80% of total billed charges,7.68,37.27,,6.14,percent of total billed charges,37.27% of total billed charges,7.68,37.27,,6.14,percent of total billed charges,37.27% of total billed charges,7.68,37.27,,6.14,percent of total billed charges,37.27% 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,8.24,40,,6.59,percent of total billed charges,40% of total billed charges,7.68,16.48,
VASOTEC 5MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,3.1,2.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.48,80,,1.98,percent of total billed charges,80% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% 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,1.24,40,,0.99,percent of total billed charges,40% of total billed charges,1.16,2.48,
VASOTEC 10MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,3.45,2.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.76,80,,2.21,percent of total billed charges,80% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% 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,1.38,40,,1.1,percent of total billed charges,40% of total billed charges,1.29,2.76,
AMITRIPTYLINE 75MG T,6400014,CDM,250,RC,,,Outpatient,,,3.2,2.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,80,,2.05,percent of total billed charges,80% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% 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,1.28,40,,1.02,percent of total billed charges,40% of total billed charges,1.19,2.56,
GLUCOTROL 10MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,2.35,1.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.88,80,,1.5,percent of total billed charges,80% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% 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,0.94,40,,0.75,percent of total billed charges,40% of total billed charges,0.88,1.88,
TRUSOPT 2% OPTHAL SO,6400014,CDM,250,RC,,,Outpatient,,,115.05,92.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.04,80,,73.63,percent of total billed charges,80% of total billed charges,42.88,37.27,,34.3,percent of total billed charges,37.27% of total billed charges,42.88,37.27,,34.3,percent of total billed charges,37.27% of total billed charges,42.88,37.27,,34.3,percent of total billed charges,37.27% 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,46.02,40,,36.82,percent of total billed charges,40% of total billed charges,42.88,92.04,
DIPHENOXYLATE HCL,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
MEVACOR 20MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,8.2,6.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.56,80,,5.25,percent of total billed charges,80% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% 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,3.28,40,,2.62,percent of total billed charges,40% of total billed charges,3.06,6.56,
MYCELEX TROCHE 10MG,6400014,CDM,250,RC,,,Outpatient,,,5.45,4.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.36,80,,3.49,percent of total billed charges,80% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% 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,2.18,40,,1.74,percent of total billed charges,40% of total billed charges,2.03,4.36,
NAPROSYN 375MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,4.7,3.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.76,80,,3.01,percent of total billed charges,80% of total billed charges,1.75,37.27,,1.4,percent of total billed charges,37.27% of total billed charges,1.75,37.27,,1.4,percent of total billed charges,37.27% of total billed charges,1.75,37.27,,1.4,percent of total billed charges,37.27% 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,1.88,40,,1.5,percent of total billed charges,40% of total billed charges,1.75,3.76,
AMITRIPTYLINE 100MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ANSAID 100MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,4.2,3.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.36,80,,2.69,percent of total billed charges,80% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% 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,1.68,40,,1.34,percent of total billed charges,40% of total billed charges,1.57,3.36,
BENADRYL 25MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
BENADRYL 50MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
BRETHINE 5MG TAB U/D,6400014,CDM,250,RC,,,Outpatient,,,2.1,1.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,80,,1.34,percent of total billed charges,80% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% 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,0.84,40,,0.67,percent of total billed charges,40% of total billed charges,0.78,1.68,
CARDIZEM SR 90MG CAP,6400014,CDM,250,RC,,,Outpatient,,,12.35,9.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.88,80,,7.9,percent of total billed charges,80% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% 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,4.94,40,,3.95,percent of total billed charges,40% of total billed charges,4.6,9.88,
CARDIZEM 30MG TAB U/,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
CARDIZEM 60MG TAB U/,6400014,CDM,250,RC,,,Outpatient,,,2.6,2.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.08,80,,1.66,percent of total billed charges,80% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% 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,1.04,40,,0.83,percent of total billed charges,40% of total billed charges,0.97,2.08,
CARISOPRODOL 350MG T,6400014,CDM,250,RC,,,Outpatient,,,2.4,1.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,80,,1.54,percent of total billed charges,80% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% 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,0.96,40,,0.77,percent of total billed charges,40% of total billed charges,0.89,1.92,
WELLBUTRIN SR 100 TA,6400014,CDM,250,RC,,,Outpatient,,,13.2,10.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.56,80,,8.45,percent of total billed charges,80% of total billed charges,4.92,37.27,,3.94,percent of total billed charges,37.27% of total billed charges,4.92,37.27,,3.94,percent of total billed charges,37.27% of total billed charges,4.92,37.27,,3.94,percent of total billed charges,37.27% 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,5.28,40,,4.22,percent of total billed charges,40% of total billed charges,4.92,10.56,
DIAZEPAM 2MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
DIAZEPAM 5MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
HYDROXYZINE 50MG CAP,6400014,CDM,250,RC,,,Outpatient,,,2.1,1.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,80,,1.34,percent of total billed charges,80% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% 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,0.84,40,,0.67,percent of total billed charges,40% of total billed charges,0.78,1.68,
LITHIUM CARBONATE 30,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
SANDOSTATIN OCTREOTI,6065130,CDM,636,RC,J2354,HCPCS,Outpatient,,,315.35,252.28,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.28,80,,201.82,percent of total billed charges,80% of total billed charges,117.53,37.27,,94.02,percent of total billed charges,37.27% of total billed charges,117.53,37.27,,94.02,percent of total billed charges,37.27% of total billed charges,117.53,37.27,,94.02,percent of total billed charges,37.27% 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,126.14,40,,100.91,percent of total billed charges,40% of total billed charges,117.53,252.28,
HAVRIX 1440 EL.U./1M,6065130,CDM,636,RC,90632,HCPCS,Outpatient,,,301.25,241.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,241,80,,192.8,percent of total billed charges,80% of total billed charges,112.28,37.27,,89.82,percent of total billed charges,37.27% of total billed charges,112.28,37.27,,89.82,percent of total billed charges,37.27% of total billed charges,112.28,37.27,,89.82,percent of total billed charges,37.27% 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,120.5,40,,96.4,percent of total billed charges,40% of total billed charges,112.28,241,
GLUCOPHAGE TAB 850MG,6400014,CDM,250,RC,,,Outpatient,,,4.95,3.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.96,80,,3.17,percent of total billed charges,80% of total billed charges,1.84,37.27,,1.47,percent of total billed charges,37.27% of total billed charges,1.84,37.27,,1.47,percent of total billed charges,37.27% of total billed charges,1.84,37.27,,1.47,percent of total billed charges,37.27% 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,1.98,40,,1.58,percent of total billed charges,40% of total billed charges,1.84,3.96,
MELATONIN,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ARTHROTEC TABLET 50M,6400014,CDM,250,RC,,,Outpatient,,,6.05,4.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,80,,3.87,percent of total billed charges,80% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% 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,2.42,40,,1.94,percent of total billed charges,40% of total billed charges,2.25,4.84,
ARTHROTEC TABLET 75M,6400014,CDM,250,RC,,,Outpatient,,,4.36,3.49,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.49,80,,2.79,percent of total billed charges,80% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% 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,1.74,40,,1.39,percent of total billed charges,40% of total billed charges,1.62,3.49,
ZEBETA 5MG TAB (BISO,6400014,CDM,250,RC,,,Outpatient,,,4.75,3.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.8,80,,3.04,percent of total billed charges,80% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% 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,1.9,40,,1.52,percent of total billed charges,40% of total billed charges,1.77,3.8,
AVAPRO 150MG (IRBESA,6400014,CDM,250,RC,,,Outpatient,,,11.6,9.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,80,,7.42,percent of total billed charges,80% of total billed charges,4.32,37.27,,3.46,percent of total billed charges,37.27% of total billed charges,4.32,37.27,,3.46,percent of total billed charges,37.27% of total billed charges,4.32,37.27,,3.46,percent of total billed charges,37.27% 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,4.64,40,,3.71,percent of total billed charges,40% of total billed charges,4.32,9.28,
ALLEGRA 60MG CAP,6400014,CDM,250,RC,,,Outpatient,,,5.6,4.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,80,,3.58,percent of total billed charges,80% of total billed charges,2.09,37.27,,1.67,percent of total billed charges,37.27% of total billed charges,2.09,37.27,,1.67,percent of total billed charges,37.27% of total billed charges,2.09,37.27,,1.67,percent of total billed charges,37.27% 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,2.24,40,,1.79,percent of total billed charges,40% of total billed charges,2.09,4.48,
VALTREX 500MG CAPS,6400014,CDM,250,RC,,,Outpatient,,,9.11,7.29,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.29,80,,5.83,percent of total billed charges,80% of total billed charges,3.4,37.27,,2.72,percent of total billed charges,37.27% of total billed charges,3.4,37.27,,2.72,percent of total billed charges,37.27% of total billed charges,3.4,37.27,,2.72,percent of total billed charges,37.27% 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,3.64,40,,2.91,percent of total billed charges,40% of total billed charges,3.4,7.29,
ZYPREXA 5MG (OLANZAP,6400014,CDM,250,RC,,,Outpatient,,,19.02,15.22,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.22,80,,12.18,percent of total billed charges,80% of total billed charges,7.09,37.27,,5.67,percent of total billed charges,37.27% of total billed charges,7.09,37.27,,5.67,percent of total billed charges,37.27% of total billed charges,7.09,37.27,,5.67,percent of total billed charges,37.27% 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,7.61,40,,6.09,percent of total billed charges,40% of total billed charges,7.09,15.22,
ZOSYN 4.5 GM,6065130,CDM,636,RC,J2543,HCPCS,Outpatient,,,69.4,55.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.52,80,,44.42,percent of total billed charges,80% of total billed charges,25.87,37.27,,20.7,percent of total billed charges,37.27% of total billed charges,25.87,37.27,,20.7,percent of total billed charges,37.27% of total billed charges,25.87,37.27,,20.7,percent of total billed charges,37.27% 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,27.76,40,,22.21,percent of total billed charges,40% of total billed charges,25.87,55.52,
PROAMATINE 2.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,14.4,11.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.52,80,,9.22,percent of total billed charges,80% of total billed charges,5.37,37.27,,4.3,percent of total billed charges,37.27% of total billed charges,5.37,37.27,,4.3,percent of total billed charges,37.27% of total billed charges,5.37,37.27,,4.3,percent of total billed charges,37.27% 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,5.76,40,,4.61,percent of total billed charges,40% of total billed charges,5.37,11.52,
AVEENO BATH O.L,6400014,CDM,250,RC,,,Outpatient,,,17.2,13.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.76,80,,11.01,percent of total billed charges,80% of total billed charges,6.41,37.27,,5.13,percent of total billed charges,37.27% of total billed charges,6.41,37.27,,5.13,percent of total billed charges,37.27% of total billed charges,6.41,37.27,,5.13,percent of total billed charges,37.27% 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,6.88,40,,5.5,percent of total billed charges,40% of total billed charges,6.41,13.76,
ASTELIN NASAL SPRAY,6400014,CDM,250,RC,,,Outpatient,,,183.55,146.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.84,80,,117.47,percent of total billed charges,80% of total billed charges,68.41,37.27,,54.73,percent of total billed charges,37.27% of total billed charges,68.41,37.27,,54.73,percent of total billed charges,37.27% of total billed charges,68.41,37.27,,54.73,percent of total billed charges,37.27% 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,73.42,40,,58.74,percent of total billed charges,40% of total billed charges,68.41,146.84,
TETRACAINE POPSICLE,6400014,CDM,250,RC,,,Outpatient,,,17.5,14.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14,80,,11.2,percent of total billed charges,80% of total billed charges,6.52,37.27,,5.22,percent of total billed charges,37.27% of total billed charges,6.52,37.27,,5.22,percent of total billed charges,37.27% of total billed charges,6.52,37.27,,5.22,percent of total billed charges,37.27% 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,7,40,,5.6,percent of total billed charges,40% of total billed charges,6.52,14,
FLOMAX 0.4 MG CAP (T,6400014,CDM,250,RC,,,Outpatient,,,36.2,28.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.96,80,,23.17,percent of total billed charges,80% of total billed charges,13.49,37.27,,10.79,percent of total billed charges,37.27% of total billed charges,13.49,37.27,,10.79,percent of total billed charges,37.27% of total billed charges,13.49,37.27,,10.79,percent of total billed charges,37.27% 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,14.48,40,,11.58,percent of total billed charges,40% of total billed charges,13.49,28.96,
CHROMAGEN FA CAP,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
AVAPRO 300MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
XYLOCAINE 2% JELLY U,6400014,CDM,250,RC,,,Outpatient,,,28.65,22.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.92,80,,18.34,percent of total billed charges,80% of total billed charges,10.68,37.27,,8.54,percent of total billed charges,37.27% of total billed charges,10.68,37.27,,8.54,percent of total billed charges,37.27% of total billed charges,10.68,37.27,,8.54,percent of total billed charges,37.27% 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,11.46,40,,9.17,percent of total billed charges,40% of total billed charges,10.68,22.92,
MILK OF MAGNESIA CON,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
MILK OF MAG/CASCARA,6400014,CDM,250,RC,,,Outpatient,,,3.45,2.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.76,80,,2.21,percent of total billed charges,80% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% 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,1.38,40,,1.1,percent of total billed charges,40% of total billed charges,1.29,2.76,
MOTRIN 800MG UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
NITRO-DUR 0.1MG,6400014,CDM,250,RC,,,Outpatient,,,6.3,5.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,80,,4.03,percent of total billed charges,80% of total billed charges,2.35,37.27,,1.88,percent of total billed charges,37.27% of total billed charges,2.35,37.27,,1.88,percent of total billed charges,37.27% of total billed charges,2.35,37.27,,1.88,percent of total billed charges,37.27% 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,2.52,40,,2.02,percent of total billed charges,40% of total billed charges,2.35,5.04,
NITRO-DUR 0.2MG/HR 1,6400014,CDM,250,RC,,,Outpatient,,,5.35,4.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.28,80,,3.42,percent of total billed charges,80% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% 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,2.14,40,,1.71,percent of total billed charges,40% of total billed charges,1.99,4.28,
NITRO-DUR 0.4MG/HR,6400014,CDM,250,RC,,,Outpatient,,,5.35,4.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.28,80,,3.42,percent of total billed charges,80% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% 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,2.14,40,,1.71,percent of total billed charges,40% of total billed charges,1.99,4.28,
NITRO-DUR 0.6MG/HR,6400014,CDM,250,RC,,,Outpatient,,,5.35,4.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.28,80,,3.42,percent of total billed charges,80% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% 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,2.14,40,,1.71,percent of total billed charges,40% of total billed charges,1.99,4.28,
NITROCLYCERIN OINT,6400014,CDM,250,RC,,,Outpatient,,,136.2,108.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.96,80,,87.17,percent of total billed charges,80% of total billed charges,50.76,37.27,,40.61,percent of total billed charges,37.27% of total billed charges,50.76,37.27,,40.61,percent of total billed charges,37.27% of total billed charges,50.76,37.27,,40.61,percent of total billed charges,37.27% 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,54.48,40,,43.58,percent of total billed charges,40% of total billed charges,50.76,108.96,
NORMODYNE TAB 200MG,6400014,CDM,250,RC,,,Outpatient,,,2.2,1.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,80,,1.41,percent of total billed charges,80% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% 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,0.88,40,,0.7,percent of total billed charges,40% of total billed charges,0.82,1.76,
POLYMOX CAP 250MG UD,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
POLYMOX CAP 500MG UD,6400014,CDM,250,RC,,,Outpatient,,,4.55,3.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.64,80,,2.91,percent of total billed charges,80% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% 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,1.82,40,,1.46,percent of total billed charges,40% of total billed charges,1.7,3.64,
PROPRANOLOL 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PROPANTHELINE 15MG T,6400014,CDM,250,RC,,,Outpatient,,,2.05,1.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.64,80,,1.31,percent of total billed charges,80% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% 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,0.82,40,,0.66,percent of total billed charges,40% of total billed charges,0.76,1.64,
PROPRANOLOL 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.05,1.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.64,80,,1.31,percent of total billed charges,80% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% of total billed charges,0.76,37.27,,0.61,percent of total billed charges,37.27% 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,0.82,40,,0.66,percent of total billed charges,40% of total billed charges,0.76,1.64,
PROVENTIL REPETAB 4M,6400014,CDM,250,RC,,,Outpatient,,,2.6,2.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.08,80,,1.66,percent of total billed charges,80% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% of total billed charges,0.97,37.27,,0.78,percent of total billed charges,37.27% 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,1.04,40,,0.83,percent of total billed charges,40% of total billed charges,0.97,2.08,
REGLAN 10MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,3.25,2.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.6,80,,2.08,percent of total billed charges,80% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% 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,1.3,40,,1.04,percent of total billed charges,40% of total billed charges,1.21,2.6,
REGLAN 5MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
SULFATRIM DS TAB UD,6400014,CDM,250,RC,,,Outpatient,,,3.9,3.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.12,80,,2.5,percent of total billed charges,80% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% 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,1.56,40,,1.25,percent of total billed charges,40% of total billed charges,1.45,3.12,
SLO BID CAP 200MG UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SLO BID CAP 300MG UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
TAGAMET 300MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,7,5.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
TEGRETOL 200MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,2.5,2.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
TENORMIN 50MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,3.2,2.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,80,,2.05,percent of total billed charges,80% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% 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,1.28,40,,1.02,percent of total billed charges,40% of total billed charges,1.19,2.56,
ZESTRIL 10MG TAB U/D,6400014,CDM,250,RC,,,Outpatient,,,3.2,2.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,80,,2.05,percent of total billed charges,80% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% 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,1.28,40,,1.02,percent of total billed charges,40% of total billed charges,1.19,2.56,
CORVERT INJ (IBUTILI,6065130,CDM,636,RC,J1742,HCPCS,Outpatient,,,1159.15,927.32,JG,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,927.32,80,,741.86,percent of total billed charges,80% of total billed charges,432.02,37.27,,345.62,percent of total billed charges,37.27% of total billed charges,432.02,37.27,,345.62,percent of total billed charges,37.27% of total billed charges,432.02,37.27,,345.62,percent of total billed charges,37.27% of total billed charges,241.4,100,,,fee schedule,100% of APC rate,241.4,100,,,fee schedule,100% of APC rate,241.4,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,241.4,100,,,fee schedule,100% of APC rate,241.4,100,,,fee schedule,100% of APC rate,241.4,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,463.66,40,,370.93,percent of total billed charges,40% of total billed charges,241.4,927.32,
AVELOX 400MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,118.25,94.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.6,80,,75.68,percent of total billed charges,80% of total billed charges,44.07,37.27,,35.26,percent of total billed charges,37.27% of total billed charges,44.07,37.27,,35.26,percent of total billed charges,37.27% of total billed charges,44.07,37.27,,35.26,percent of total billed charges,37.27% 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,47.3,40,,37.84,percent of total billed charges,40% of total billed charges,44.07,94.6,
HUMALOG MIX 75/25 PE,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,57.85,46.28,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.28,80,,37.02,percent of total billed charges,80% of total billed charges,21.56,37.27,,17.25,percent of total billed charges,37.27% of total billed charges,21.56,37.27,,17.25,percent of total billed charges,37.27% of total billed charges,21.56,37.27,,17.25,percent of total billed charges,37.27% 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,23.14,40,,18.51,percent of total billed charges,40% of total billed charges,21.56,46.28,
CLIMARA 0.1MG/DAY PA,6400014,CDM,250,RC,,,Outpatient,,,133.2,106.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.56,80,,85.25,percent of total billed charges,80% of total billed charges,49.64,37.27,,39.71,percent of total billed charges,37.27% of total billed charges,49.64,37.27,,39.71,percent of total billed charges,37.27% of total billed charges,49.64,37.27,,39.71,percent of total billed charges,37.27% 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,53.28,40,,42.62,percent of total billed charges,40% of total billed charges,49.64,106.56,
CLIMARA 0.075MG/DAY,6400014,CDM,250,RC,,,Outpatient,,,133.2,106.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.56,80,,85.25,percent of total billed charges,80% of total billed charges,49.64,37.27,,39.71,percent of total billed charges,37.27% of total billed charges,49.64,37.27,,39.71,percent of total billed charges,37.27% of total billed charges,49.64,37.27,,39.71,percent of total billed charges,37.27% 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,53.28,40,,42.62,percent of total billed charges,40% of total billed charges,49.64,106.56,
CLIMARA 0.05MG/DAY P,6400014,CDM,250,RC,,,Outpatient,,,83.8,67.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.04,80,,53.63,percent of total billed charges,80% of total billed charges,31.23,37.27,,24.98,percent of total billed charges,37.27% of total billed charges,31.23,37.27,,24.98,percent of total billed charges,37.27% of total billed charges,31.23,37.27,,24.98,percent of total billed charges,37.27% 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,33.52,40,,26.82,percent of total billed charges,40% of total billed charges,31.23,67.04,
CLIMARA 0.025MG/DAY,6400014,CDM,250,RC,,,Outpatient,,,133.2,106.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.56,80,,85.25,percent of total billed charges,80% of total billed charges,49.64,37.27,,39.71,percent of total billed charges,37.27% of total billed charges,49.64,37.27,,39.71,percent of total billed charges,37.27% of total billed charges,49.64,37.27,,39.71,percent of total billed charges,37.27% 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,53.28,40,,42.62,percent of total billed charges,40% of total billed charges,49.64,106.56,
IV D50W 500CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV D5W 25CC,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
COREG TAB 3.125 MG,6400014,CDM,250,RC,,,Outpatient,,,7.8,6.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.24,80,,4.99,percent of total billed charges,80% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% 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,3.12,40,,2.5,percent of total billed charges,40% of total billed charges,2.91,6.24,
SIMETHICONE 40MG (MY,6400014,CDM,250,RC,,,Outpatient,,,15.48,12.38,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.38,80,,9.9,percent of total billed charges,80% of total billed charges,5.77,37.27,,4.62,percent of total billed charges,37.27% of total billed charges,5.77,37.27,,4.62,percent of total billed charges,37.27% of total billed charges,5.77,37.27,,4.62,percent of total billed charges,37.27% 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,6.19,40,,4.95,percent of total billed charges,40% of total billed charges,5.77,12.38,
TRAZODONE 50MG TAB D,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
FENTANYL INJ 5ML,6065130,CDM,636,RC,J3010,HCPCS,Outpatient,,,25.15,20.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.12,80,,16.1,percent of total billed charges,80% of total billed charges,9.37,37.27,,7.5,percent of total billed charges,37.27% of total billed charges,9.37,37.27,,7.5,percent of total billed charges,37.27% of total billed charges,9.37,37.27,,7.5,percent of total billed charges,37.27% 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,10.06,40,,8.05,percent of total billed charges,40% of total billed charges,9.37,20.12,
SALINEX NASAL SPRAY,6400014,CDM,250,RC,,,Outpatient,,,15.71,12.57,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.57,80,,10.06,percent of total billed charges,80% of total billed charges,5.86,37.27,,4.69,percent of total billed charges,37.27% of total billed charges,5.86,37.27,,4.69,percent of total billed charges,37.27% of total billed charges,5.86,37.27,,4.69,percent of total billed charges,37.27% 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,6.28,40,,5.02,percent of total billed charges,40% of total billed charges,5.86,12.57,
FLONASE NASAL SPRAY,6400014,CDM,250,RC,,,Outpatient,,,236.85,189.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.48,80,,151.58,percent of total billed charges,80% of total billed charges,88.27,37.27,,70.62,percent of total billed charges,37.27% of total billed charges,88.27,37.27,,70.62,percent of total billed charges,37.27% of total billed charges,88.27,37.27,,70.62,percent of total billed charges,37.27% 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,94.74,40,,75.79,percent of total billed charges,40% of total billed charges,88.27,189.48,
ALEVE 220MG TAB NAPR,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
BUMEX 1MG/4ML INJ,6065130,CDM,636,RC,J1939,HCPCS,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
LAMISIL TABLETS 250M,6400014,CDM,250,RC,,,Outpatient,,,52.65,42.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.12,80,,33.7,percent of total billed charges,80% of total billed charges,19.62,37.27,,15.7,percent of total billed charges,37.27% of total billed charges,19.62,37.27,,15.7,percent of total billed charges,37.27% of total billed charges,19.62,37.27,,15.7,percent of total billed charges,37.27% 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,21.06,40,,16.85,percent of total billed charges,40% of total billed charges,19.62,42.12,
VANTIN 200MG (CEFPOD,6400014,CDM,250,RC,,,Outpatient,,,33.35,26.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.68,80,,21.34,percent of total billed charges,80% of total billed charges,12.43,37.27,,9.94,percent of total billed charges,37.27% of total billed charges,12.43,37.27,,9.94,percent of total billed charges,37.27% of total billed charges,12.43,37.27,,9.94,percent of total billed charges,37.27% 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,13.34,40,,10.67,percent of total billed charges,40% of total billed charges,12.43,26.68,
"VIT A 10,000 UNITS C",6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
DURAGESIC PATCH 75MC,6400014,CDM,250,RC,,,Outpatient,,,447.2,357.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,357.76,80,,286.21,percent of total billed charges,80% of total billed charges,166.67,37.27,,133.34,percent of total billed charges,37.27% of total billed charges,166.67,37.27,,133.34,percent of total billed charges,37.27% of total billed charges,166.67,37.27,,133.34,percent of total billed charges,37.27% 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,178.88,40,,143.1,percent of total billed charges,40% of total billed charges,166.67,357.76,
PRANDIN 1MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,23.3,18.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.64,80,,14.91,percent of total billed charges,80% of total billed charges,8.68,37.27,,6.94,percent of total billed charges,37.27% of total billed charges,8.68,37.27,,6.94,percent of total billed charges,37.27% of total billed charges,8.68,37.27,,6.94,percent of total billed charges,37.27% 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,9.32,40,,7.46,percent of total billed charges,40% of total billed charges,8.68,18.64,
EX-DEC-TR TABLET SA,6400014,CDM,250,RC,,,Outpatient,,,2.5,2.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
ENTEX LA TABLET SA,6400014,CDM,250,RC,,,Outpatient,,,4.66,3.73,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.73,80,,2.98,percent of total billed charges,80% of total billed charges,1.74,37.27,,1.39,percent of total billed charges,37.27% of total billed charges,1.74,37.27,,1.39,percent of total billed charges,37.27% of total billed charges,1.74,37.27,,1.39,percent of total billed charges,37.27% 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,1.86,40,,1.49,percent of total billed charges,40% of total billed charges,1.74,3.73,
ARTHRICREAM 10% RUB,6400014,CDM,250,RC,,,Outpatient,,,13.65,10.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.92,80,,8.74,percent of total billed charges,80% of total billed charges,5.09,37.27,,4.07,percent of total billed charges,37.27% of total billed charges,5.09,37.27,,4.07,percent of total billed charges,37.27% of total billed charges,5.09,37.27,,4.07,percent of total billed charges,37.27% 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,5.46,40,,4.37,percent of total billed charges,40% of total billed charges,5.09,10.92,
COUMADIN TAB 1MG UD,6400014,CDM,250,RC,,,Outpatient,,,8.4,6.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,80,,5.38,percent of total billed charges,80% of total billed charges,3.13,37.27,,2.5,percent of total billed charges,37.27% of total billed charges,3.13,37.27,,2.5,percent of total billed charges,37.27% of total billed charges,3.13,37.27,,2.5,percent of total billed charges,37.27% 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,3.36,40,,2.69,percent of total billed charges,40% of total billed charges,3.13,6.72,
COMBIVENT INH,6400014,CDM,250,RC,,,Outpatient,,,677.45,541.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,541.96,80,,433.57,percent of total billed charges,80% of total billed charges,252.49,37.27,,201.99,percent of total billed charges,37.27% of total billed charges,252.49,37.27,,201.99,percent of total billed charges,37.27% of total billed charges,252.49,37.27,,201.99,percent of total billed charges,37.27% 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,270.98,40,,216.78,percent of total billed charges,40% of total billed charges,252.49,541.96,
CELEXA 20MG TAB (CIT,6400014,CDM,250,RC,,,Outpatient,,,13.65,10.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.92,80,,8.74,percent of total billed charges,80% of total billed charges,5.09,37.27,,4.07,percent of total billed charges,37.27% of total billed charges,5.09,37.27,,4.07,percent of total billed charges,37.27% of total billed charges,5.09,37.27,,4.07,percent of total billed charges,37.27% 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,5.46,40,,4.37,percent of total billed charges,40% of total billed charges,5.09,10.92,
COREG 12.5MG TAB (CA,6400014,CDM,250,RC,,,Outpatient,,,7.8,6.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.24,80,,4.99,percent of total billed charges,80% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% 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,3.12,40,,2.5,percent of total billed charges,40% of total billed charges,2.91,6.24,
DEPO-PROVERA 150MG S,6065130,CDM,636,RC,J1050,HCPCS,Outpatient,,,754,603.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,603.2,80,,482.56,percent of total billed charges,80% of total billed charges,281.02,37.27,,224.82,percent of total billed charges,37.27% of total billed charges,281.02,37.27,,224.82,percent of total billed charges,37.27% of total billed charges,281.02,37.27,,224.82,percent of total billed charges,37.27% 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,301.6,40,,241.28,percent of total billed charges,40% of total billed charges,281.02,603.2,
COREG 25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,7.8,6.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.24,80,,4.99,percent of total billed charges,80% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% 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,3.12,40,,2.5,percent of total billed charges,40% of total billed charges,2.91,6.24,
NS 50ML MINIBAG,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
NS 100ML MINIBAG,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
UNIRETIC 15/25 MG,6400014,CDM,250,RC,,,Outpatient,,,1.82,1.46,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.46,80,,1.17,percent of total billed charges,80% of total billed charges,0.68,37.27,,0.54,percent of total billed charges,37.27% of total billed charges,0.68,37.27,,0.54,percent of total billed charges,37.27% of total billed charges,0.68,37.27,,0.54,percent of total billed charges,37.27% 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,0.73,40,,0.58,percent of total billed charges,40% of total billed charges,0.68,1.46,
LORTAB 7.5/500 TAB U,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
LOSOPAN SUSPENSION,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
NASALIDE 0.025% SPRA,6400014,CDM,250,RC,,,Outpatient,,,187.75,150.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.2,80,,120.16,percent of total billed charges,80% of total billed charges,69.97,37.27,,55.98,percent of total billed charges,37.27% of total billed charges,69.97,37.27,,55.98,percent of total billed charges,37.27% of total billed charges,69.97,37.27,,55.98,percent of total billed charges,37.27% 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,75.1,40,,60.08,percent of total billed charges,40% of total billed charges,69.97,150.2,
NEURONTIN 100MG CAP,6400014,CDM,250,RC,,,Outpatient,,,2.75,2.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.2,80,,1.76,percent of total billed charges,80% of total billed charges,1.02,37.27,,0.82,percent of total billed charges,37.27% of total billed charges,1.02,37.27,,0.82,percent of total billed charges,37.27% of total billed charges,1.02,37.27,,0.82,percent of total billed charges,37.27% 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,1.1,40,,0.88,percent of total billed charges,40% of total billed charges,1.02,2.2,
AMARYL 2MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,3.05,2.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.44,80,,1.95,percent of total billed charges,80% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% 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,1.22,40,,0.98,percent of total billed charges,40% of total billed charges,1.14,2.44,
GLYCERIN SUPP (ADULT,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
ROBITUSSIN-DM SYRUP,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
NASONEX NASAL SPRAY,6400014,CDM,250,RC,,,Outpatient,,,544.95,435.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,435.96,80,,348.77,percent of total billed charges,80% of total billed charges,203.1,37.27,,162.48,percent of total billed charges,37.27% of total billed charges,203.1,37.27,,162.48,percent of total billed charges,37.27% of total billed charges,203.1,37.27,,162.48,percent of total billed charges,37.27% 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,217.98,40,,174.38,percent of total billed charges,40% of total billed charges,203.1,435.96,
ZINC 100MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ZANAFLEX,6400014,CDM,250,RC,,,Outpatient,,,5.35,4.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.28,80,,3.42,percent of total billed charges,80% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% 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,2.14,40,,1.71,percent of total billed charges,40% of total billed charges,1.99,4.28,
PLAVIX 75MG TAB (CLO,6400014,CDM,250,RC,,,Outpatient,,,26.35,21.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.08,80,,16.86,percent of total billed charges,80% of total billed charges,9.82,37.27,,7.86,percent of total billed charges,37.27% of total billed charges,9.82,37.27,,7.86,percent of total billed charges,37.27% of total billed charges,9.82,37.27,,7.86,percent of total billed charges,37.27% 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,10.54,40,,8.43,percent of total billed charges,40% of total billed charges,9.82,21.08,
GUAIFEN/P-EPHEN TAB,6400014,CDM,250,RC,,,Outpatient,,,2.2,1.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,80,,1.41,percent of total billed charges,80% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% 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,0.88,40,,0.7,percent of total billed charges,40% of total billed charges,0.82,1.76,
ACCUZYME OINTMENT 30,6400014,CDM,250,RC,,,Outpatient,,,171.45,137.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.16,80,,109.73,percent of total billed charges,80% of total billed charges,63.9,37.27,,51.12,percent of total billed charges,37.27% of total billed charges,63.9,37.27,,51.12,percent of total billed charges,37.27% of total billed charges,63.9,37.27,,51.12,percent of total billed charges,37.27% 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,68.58,40,,54.86,percent of total billed charges,40% of total billed charges,63.9,137.16,
ARICEPT 5MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,32.05,25.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.64,80,,20.51,percent of total billed charges,80% of total billed charges,11.95,37.27,,9.56,percent of total billed charges,37.27% of total billed charges,11.95,37.27,,9.56,percent of total billed charges,37.27% of total billed charges,11.95,37.27,,9.56,percent of total billed charges,37.27% 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,12.82,40,,10.26,percent of total billed charges,40% of total billed charges,11.95,25.64,
COVERA HS 180MG (VER,6400014,CDM,250,RC,,,Outpatient,,,8.7,6.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.96,80,,5.57,percent of total billed charges,80% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% of total billed charges,3.24,37.27,,2.59,percent of total billed charges,37.27% 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,3.48,40,,2.78,percent of total billed charges,40% of total billed charges,3.24,6.96,
POLY-TUSSIN SRP(5ML),6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
RESOURCE 8 OZ,6400014,CDM,250,RC,,,Outpatient,,,5.1,4.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.08,80,,3.26,percent of total billed charges,80% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% 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,2.04,40,,1.63,percent of total billed charges,40% of total billed charges,1.9,4.08,
CALTRATE & D,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PANCOF_HC (OZ),6400014,CDM,250,RC,,,Outpatient,,,7.75,6.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.2,80,,4.96,percent of total billed charges,80% of total billed charges,2.89,37.27,,2.31,percent of total billed charges,37.27% of total billed charges,2.89,37.27,,2.31,percent of total billed charges,37.27% of total billed charges,2.89,37.27,,2.31,percent of total billed charges,37.27% 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,3.1,40,,2.48,percent of total billed charges,40% of total billed charges,2.89,6.2,
NEUPOGEN 480MCG/136M,6065130,CDM,636,RC,J1442,HCPCS,Outpatient,,,1708.1,1366.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1366.48,80,,1093.18,percent of total billed charges,80% of total billed charges,636.61,37.27,,509.29,percent of total billed charges,37.27% of total billed charges,636.61,37.27,,509.29,percent of total billed charges,37.27% of total billed charges,636.61,37.27,,509.29,percent of total billed charges,37.27% of total billed charges,1,100,,,fee schedule,100% of APC rate,1,100,,,fee schedule,100% of APC rate,1,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1,100,,,fee schedule,100% of APC rate,1,100,,,fee schedule,100% of APC rate,1,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,683.24,40,,546.59,percent of total billed charges,40% of total billed charges,1,1366.48,
ZYRTEC 10MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,8.5,6.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.8,80,,5.44,percent of total billed charges,80% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% 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,3.4,40,,2.72,percent of total billed charges,40% of total billed charges,3.17,6.8,
ROMAZICON INJ (PER M,6400014,CDM,250,RC,,,Outpatient,,,21.54,17.23,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.23,80,,13.78,percent of total billed charges,80% of total billed charges,8.03,37.27,,6.42,percent of total billed charges,37.27% of total billed charges,8.03,37.27,,6.42,percent of total billed charges,37.27% of total billed charges,8.03,37.27,,6.42,percent of total billed charges,37.27% 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,8.62,40,,6.9,percent of total billed charges,40% of total billed charges,8.03,17.23,
LEVSIN ELIXIR,6400014,CDM,250,RC,,,Outpatient,,,10.69,8.55,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.55,80,,6.84,percent of total billed charges,80% of total billed charges,3.98,37.27,,3.18,percent of total billed charges,37.27% of total billed charges,3.98,37.27,,3.18,percent of total billed charges,37.27% of total billed charges,3.98,37.27,,3.18,percent of total billed charges,37.27% 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,4.28,40,,3.42,percent of total billed charges,40% of total billed charges,3.98,8.55,
WELLBUTRIN-SR 150MG,6400014,CDM,250,RC,,,Outpatient,,,20.35,16.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.28,80,,13.02,percent of total billed charges,80% of total billed charges,7.58,37.27,,6.06,percent of total billed charges,37.27% of total billed charges,7.58,37.27,,6.06,percent of total billed charges,37.27% of total billed charges,7.58,37.27,,6.06,percent of total billed charges,37.27% 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,8.14,40,,6.51,percent of total billed charges,40% of total billed charges,7.58,16.28,
MINOCYCLINE CAP 50MG,6400014,CDM,250,RC,,,Outpatient,,,20.45,16.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.36,80,,13.09,percent of total billed charges,80% of total billed charges,7.62,37.27,,6.1,percent of total billed charges,37.27% of total billed charges,7.62,37.27,,6.1,percent of total billed charges,37.27% of total billed charges,7.62,37.27,,6.1,percent of total billed charges,37.27% 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,8.18,40,,6.54,percent of total billed charges,40% of total billed charges,7.62,16.36,
METHYLPREDNISOLENE 4,6065130,CDM,636,RC,J7509,HCPCS,Outpatient,,,93.05,74.44,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.44,80,,59.55,percent of total billed charges,80% of total billed charges,34.68,37.27,,27.74,percent of total billed charges,37.27% of total billed charges,34.68,37.27,,27.74,percent of total billed charges,37.27% of total billed charges,34.68,37.27,,27.74,percent of total billed charges,37.27% 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,37.22,40,,29.78,percent of total billed charges,40% of total billed charges,34.68,74.44,
CHLORDIAZEPOXIDE,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
NAPROXEN,6400014,CDM,250,RC,,,Outpatient,,,3.56,2.85,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.85,80,,2.28,percent of total billed charges,80% of total billed charges,1.33,37.27,,1.06,percent of total billed charges,37.27% of total billed charges,1.33,37.27,,1.06,percent of total billed charges,37.27% of total billed charges,1.33,37.27,,1.06,percent of total billed charges,37.27% 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,1.42,40,,1.14,percent of total billed charges,40% of total billed charges,1.33,2.85,
NEOMYCIN (NEO-DECADR,6400014,CDM,250,RC,,,Outpatient,,,21.22,16.98,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.98,80,,13.58,percent of total billed charges,80% of total billed charges,7.91,37.27,,6.33,percent of total billed charges,37.27% of total billed charges,7.91,37.27,,6.33,percent of total billed charges,37.27% of total billed charges,7.91,37.27,,6.33,percent of total billed charges,37.27% 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,8.49,40,,6.79,percent of total billed charges,40% of total billed charges,7.91,16.98,
BETAMETHASONE VAL CR,6400014,CDM,250,RC,,,Outpatient,,,7.72,6.18,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.18,80,,4.94,percent of total billed charges,80% of total billed charges,2.88,37.27,,2.3,percent of total billed charges,37.27% of total billed charges,2.88,37.27,,2.3,percent of total billed charges,37.27% of total billed charges,2.88,37.27,,2.3,percent of total billed charges,37.27% 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,3.09,40,,2.47,percent of total billed charges,40% of total billed charges,2.88,6.18,
AMLACTIN LOTION,6400014,CDM,250,RC,,,Outpatient,,,61.6,49.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.28,80,,39.42,percent of total billed charges,80% of total billed charges,22.96,37.27,,18.37,percent of total billed charges,37.27% of total billed charges,22.96,37.27,,18.37,percent of total billed charges,37.27% of total billed charges,22.96,37.27,,18.37,percent of total billed charges,37.27% 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,24.64,40,,19.71,percent of total billed charges,40% of total billed charges,22.96,49.28,
DIPRIVAN 100ML VIAL,6400014,CDM,250,RC,,,Outpatient,,,326.76,261.41,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,261.41,80,,209.13,percent of total billed charges,80% of total billed charges,121.78,37.27,,97.42,percent of total billed charges,37.27% of total billed charges,121.78,37.27,,97.42,percent of total billed charges,37.27% of total billed charges,121.78,37.27,,97.42,percent of total billed charges,37.27% 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,130.7,40,,104.56,percent of total billed charges,40% of total billed charges,121.78,261.41,
CASODEX TABLET 50MG,6400014,CDM,250,RC,,,Outpatient,,,71.6,57.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.28,80,,45.82,percent of total billed charges,80% of total billed charges,26.69,37.27,,21.35,percent of total billed charges,37.27% of total billed charges,26.69,37.27,,21.35,percent of total billed charges,37.27% of total billed charges,26.69,37.27,,21.35,percent of total billed charges,37.27% 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,28.64,40,,22.91,percent of total billed charges,40% of total billed charges,26.69,57.28,
LIPITOR 10MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,12.6,10.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.08,80,,8.06,percent of total billed charges,80% of total billed charges,4.7,37.27,,3.76,percent of total billed charges,37.27% of total billed charges,4.7,37.27,,3.76,percent of total billed charges,37.27% of total billed charges,4.7,37.27,,3.76,percent of total billed charges,37.27% 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,5.04,40,,4.03,percent of total billed charges,40% of total billed charges,4.7,10.08,
PEPCID AC 10MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
OXYCONTIN TAB 20MG,6400014,CDM,250,RC,,,Outpatient,,,40.7,32.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.56,80,,26.05,percent of total billed charges,80% of total billed charges,15.17,37.27,,12.14,percent of total billed charges,37.27% of total billed charges,15.17,37.27,,12.14,percent of total billed charges,37.27% of total billed charges,15.17,37.27,,12.14,percent of total billed charges,37.27% 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,16.28,40,,13.02,percent of total billed charges,40% of total billed charges,15.17,32.56,
VALTREX 1 GM CAPLET,6400014,CDM,250,RC,,,Outpatient,,,54.95,43.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.96,80,,35.17,percent of total billed charges,80% of total billed charges,20.48,37.27,,16.38,percent of total billed charges,37.27% of total billed charges,20.48,37.27,,16.38,percent of total billed charges,37.27% of total billed charges,20.48,37.27,,16.38,percent of total billed charges,37.27% 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,21.98,40,,17.58,percent of total billed charges,40% of total billed charges,20.48,43.96,
CALAN 40MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CALAN SR 240MG CAP U,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
CALCIUM W/VITAMIN D,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
CALTRATE PLUS TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
CAPSAICIN 0.025% CRE,6400014,CDM,250,RC,,,Outpatient,,,21.44,17.15,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.15,80,,13.72,percent of total billed charges,80% of total billed charges,7.99,37.27,,6.39,percent of total billed charges,37.27% of total billed charges,7.99,37.27,,6.39,percent of total billed charges,37.27% of total billed charges,7.99,37.27,,6.39,percent of total billed charges,37.27% 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,8.58,40,,6.86,percent of total billed charges,40% of total billed charges,7.99,17.15,
CARBIDOPA/LEVO 25/10,6400014,CDM,250,RC,,,Outpatient,,,4.3,3.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.44,80,,2.75,percent of total billed charges,80% of total billed charges,1.6,37.27,,1.28,percent of total billed charges,37.27% of total billed charges,1.6,37.27,,1.28,percent of total billed charges,37.27% of total billed charges,1.6,37.27,,1.28,percent of total billed charges,37.27% 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,1.72,40,,1.38,percent of total billed charges,40% of total billed charges,1.6,3.44,
CARBODEC DROPS,6400014,CDM,250,RC,,,Outpatient,,,19.3,15.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.44,80,,12.35,percent of total billed charges,80% of total billed charges,7.19,37.27,,5.75,percent of total billed charges,37.27% of total billed charges,7.19,37.27,,5.75,percent of total billed charges,37.27% of total billed charges,7.19,37.27,,5.75,percent of total billed charges,37.27% 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,7.72,40,,6.18,percent of total billed charges,40% of total billed charges,7.19,15.44,
CARDURA 1MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,4.55,3.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.64,80,,2.91,percent of total billed charges,80% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% of total billed charges,1.7,37.27,,1.36,percent of total billed charges,37.27% 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,1.82,40,,1.46,percent of total billed charges,40% of total billed charges,1.7,3.64,
CARDURA 4MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,3.4,2.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.72,80,,2.18,percent of total billed charges,80% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% 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,1.36,40,,1.09,percent of total billed charges,40% of total billed charges,1.27,2.72,
CATAFLAM 50MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,5.3,4.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.24,80,,3.39,percent of total billed charges,80% of total billed charges,1.98,37.27,,1.58,percent of total billed charges,37.27% of total billed charges,1.98,37.27,,1.58,percent of total billed charges,37.27% of total billed charges,1.98,37.27,,1.58,percent of total billed charges,37.27% 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,2.12,40,,1.7,percent of total billed charges,40% of total billed charges,1.98,4.24,
CEFAZOLIN 1GM VIAL,6065130,CDM,636,RC,J0690,HCPCS,Outpatient,,,36.05,28.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.84,80,,23.07,percent of total billed charges,80% of total billed charges,13.44,37.27,,10.75,percent of total billed charges,37.27% of total billed charges,13.44,37.27,,10.75,percent of total billed charges,37.27% of total billed charges,13.44,37.27,,10.75,percent of total billed charges,37.27% 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,14.42,40,,11.54,percent of total billed charges,40% of total billed charges,13.44,28.84,
CEFUROXIME SOD 1.5GM,6065130,CDM,636,RC,J0697,HCPCS,Outpatient,,,74.7,59.76,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.76,80,,47.81,percent of total billed charges,80% of total billed charges,27.84,37.27,,22.27,percent of total billed charges,37.27% of total billed charges,27.84,37.27,,22.27,percent of total billed charges,37.27% of total billed charges,27.84,37.27,,22.27,percent of total billed charges,37.27% 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,29.88,40,,23.9,percent of total billed charges,40% of total billed charges,27.84,59.76,
CEFUROXIME SOD 750MG,6065130,CDM,636,RC,J0697,HCPCS,Outpatient,,,38.95,31.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.16,80,,24.93,percent of total billed charges,80% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% 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,15.58,40,,12.46,percent of total billed charges,40% of total billed charges,14.52,31.16,
CEFZIL 250MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,18.45,14.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.76,80,,11.81,percent of total billed charges,80% of total billed charges,6.88,37.27,,5.5,percent of total billed charges,37.27% of total billed charges,6.88,37.27,,5.5,percent of total billed charges,37.27% of total billed charges,6.88,37.27,,5.5,percent of total billed charges,37.27% 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,7.38,40,,5.9,percent of total billed charges,40% of total billed charges,6.88,14.76,
CHLORAL HYD 500MG/5M,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
CHLORPROMAZINE 10MG,6400014,CDM,250,RC,,,Outpatient,,,14.6,11.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.68,80,,9.34,percent of total billed charges,80% of total billed charges,5.44,37.27,,4.35,percent of total billed charges,37.27% of total billed charges,5.44,37.27,,4.35,percent of total billed charges,37.27% of total billed charges,5.44,37.27,,4.35,percent of total billed charges,37.27% 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,5.84,40,,4.67,percent of total billed charges,40% of total billed charges,5.44,11.68,
CAPTOPRIL 12.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,5.85,4.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.68,80,,3.74,percent of total billed charges,80% of total billed charges,2.18,37.27,,1.74,percent of total billed charges,37.27% of total billed charges,2.18,37.27,,1.74,percent of total billed charges,37.27% of total billed charges,2.18,37.27,,1.74,percent of total billed charges,37.27% 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,2.34,40,,1.87,percent of total billed charges,40% of total billed charges,2.18,4.68,
LEVAQUIN 500MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,83.8,67.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.04,80,,53.63,percent of total billed charges,80% of total billed charges,31.23,37.27,,24.98,percent of total billed charges,37.27% of total billed charges,31.23,37.27,,24.98,percent of total billed charges,37.27% of total billed charges,31.23,37.27,,24.98,percent of total billed charges,37.27% 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,33.52,40,,26.82,percent of total billed charges,40% of total billed charges,31.23,67.04,
XALATAN OPHTH SOLU 0,6400014,CDM,250,RC,,,Outpatient,,,311.55,249.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.24,80,,199.39,percent of total billed charges,80% of total billed charges,116.11,37.27,,92.89,percent of total billed charges,37.27% of total billed charges,116.11,37.27,,92.89,percent of total billed charges,37.27% of total billed charges,116.11,37.27,,92.89,percent of total billed charges,37.27% 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,124.62,40,,99.7,percent of total billed charges,40% of total billed charges,116.11,249.24,
MYLANTA SUSPENSION (,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
COVERA HS 240MG VERA,6400014,CDM,250,RC,,,Outpatient,,,5.07,4.06,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.06,80,,3.25,percent of total billed charges,80% of total billed charges,1.89,37.27,,1.51,percent of total billed charges,37.27% of total billed charges,1.89,37.27,,1.51,percent of total billed charges,37.27% of total billed charges,1.89,37.27,,1.51,percent of total billed charges,37.27% 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,2.03,40,,1.62,percent of total billed charges,40% of total billed charges,1.89,4.06,
MAGNESIUM 250MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
CAPTOPRIL 25MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,6.35,5.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.08,80,,4.06,percent of total billed charges,80% of total billed charges,2.37,37.27,,1.9,percent of total billed charges,37.27% of total billed charges,2.37,37.27,,1.9,percent of total billed charges,37.27% of total billed charges,2.37,37.27,,1.9,percent of total billed charges,37.27% 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,2.54,40,,2.03,percent of total billed charges,40% of total billed charges,2.37,5.08,
CAPTOPRIL 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,4.3,3.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.44,80,,2.75,percent of total billed charges,80% of total billed charges,1.6,37.27,,1.28,percent of total billed charges,37.27% of total billed charges,1.6,37.27,,1.28,percent of total billed charges,37.27% of total billed charges,1.6,37.27,,1.28,percent of total billed charges,37.27% 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,1.72,40,,1.38,percent of total billed charges,40% of total billed charges,1.6,3.44,
CARBAMAZEPINE 200MG,6400014,CDM,250,RC,,,Outpatient,,,5.7,4.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.56,80,,3.65,percent of total billed charges,80% of total billed charges,2.12,37.27,,1.7,percent of total billed charges,37.27% of total billed charges,2.12,37.27,,1.7,percent of total billed charges,37.27% of total billed charges,2.12,37.27,,1.7,percent of total billed charges,37.27% 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,2.28,40,,1.82,percent of total billed charges,40% of total billed charges,2.12,4.56,
CARBIDOPA/LEVO 25/25,6400014,CDM,250,RC,,,Outpatient,,,5.5,4.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.4,80,,3.52,percent of total billed charges,80% of total billed charges,2.05,37.27,,1.64,percent of total billed charges,37.27% of total billed charges,2.05,37.27,,1.64,percent of total billed charges,37.27% of total billed charges,2.05,37.27,,1.64,percent of total billed charges,37.27% 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,2.2,40,,1.76,percent of total billed charges,40% of total billed charges,2.05,4.4,
CEFACLOR 250MG CAP U,6400014,CDM,250,RC,,,Outpatient,,,7.47,5.98,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.98,80,,4.78,percent of total billed charges,80% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% 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,2.99,40,,2.39,percent of total billed charges,40% of total billed charges,2.78,5.98,
CO-ENZYME-Q10,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
AREDIA VIAL 30MG/VIA,6065130,CDM,636,RC,J2430,HCPCS,Outpatient,,,845.4,676.32,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,676.32,80,,541.06,percent of total billed charges,80% of total billed charges,315.08,37.27,,252.06,percent of total billed charges,37.27% of total billed charges,315.08,37.27,,252.06,percent of total billed charges,37.27% of total billed charges,315.08,37.27,,252.06,percent of total billed charges,37.27% 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,338.16,40,,270.53,percent of total billed charges,40% of total billed charges,315.08,676.32,
PERMAX 0.25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.14,2.51,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.51,80,,2.01,percent of total billed charges,80% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% 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,1.26,40,,1.01,percent of total billed charges,40% of total billed charges,1.17,2.51,
NEURONTIN CAP 300MG,6400014,CDM,250,RC,,,Outpatient,,,6.55,5.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.24,80,,4.19,percent of total billed charges,80% of total billed charges,2.44,37.27,,1.95,percent of total billed charges,37.27% of total billed charges,2.44,37.27,,1.95,percent of total billed charges,37.27% of total billed charges,2.44,37.27,,1.95,percent of total billed charges,37.27% 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,2.62,40,,2.1,percent of total billed charges,40% of total billed charges,2.44,5.24,
HUMALOG INSULIN,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,72.45,57.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.96,80,,46.37,percent of total billed charges,80% of total billed charges,27,37.27,,21.6,percent of total billed charges,37.27% of total billed charges,27,37.27,,21.6,percent of total billed charges,37.27% of total billed charges,27,37.27,,21.6,percent of total billed charges,37.27% 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,28.98,40,,23.18,percent of total billed charges,40% of total billed charges,27,57.96,
LIDOCAINE 2% (PER ML,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
DIPRIVAN INJ (PER ML,6400014,CDM,250,RC,,,Outpatient,,,3.27,2.62,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.62,80,,2.1,percent of total billed charges,80% of total billed charges,1.22,37.27,,0.98,percent of total billed charges,37.27% of total billed charges,1.22,37.27,,0.98,percent of total billed charges,37.27% of total billed charges,1.22,37.27,,0.98,percent of total billed charges,37.27% 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,1.31,40,,1.05,percent of total billed charges,40% of total billed charges,1.22,2.62,
LIDOCAINE 1% (PER ML,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,37.6,30.08,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,80,,24.06,percent of total billed charges,80% of total billed charges,14.01,37.27,,11.21,percent of total billed charges,37.27% of total billed charges,14.01,37.27,,11.21,percent of total billed charges,37.27% of total billed charges,14.01,37.27,,11.21,percent of total billed charges,37.27% 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,15.04,40,,12.03,percent of total billed charges,40% of total billed charges,14.01,30.08,
DIPRIVAN 50ML VIAL,6400014,CDM,250,RC,,,Outpatient,,,163.38,130.70,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.7,80,,104.56,percent of total billed charges,80% of total billed charges,60.89,37.27,,48.71,percent of total billed charges,37.27% of total billed charges,60.89,37.27,,48.71,percent of total billed charges,37.27% of total billed charges,60.89,37.27,,48.71,percent of total billed charges,37.27% 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,65.35,40,,52.28,percent of total billed charges,40% of total billed charges,60.89,130.7,
SUPLENA 1 8OZ CAN,6400014,CDM,250,RC,,,Outpatient,,,10.85,8.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.68,80,,6.94,percent of total billed charges,80% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% 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,4.34,40,,3.47,percent of total billed charges,40% of total billed charges,4.04,8.68,
LOTREL 2.5/10 CAPSUL,6400014,CDM,250,RC,,,Outpatient,,,9.05,7.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.24,80,,5.79,percent of total billed charges,80% of total billed charges,3.37,37.27,,2.7,percent of total billed charges,37.27% of total billed charges,3.37,37.27,,2.7,percent of total billed charges,37.27% of total billed charges,3.37,37.27,,2.7,percent of total billed charges,37.27% 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,3.62,40,,2.9,percent of total billed charges,40% of total billed charges,3.37,7.24,
AMITRIP/CCP 12.5-5 T,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
AMITRIP/CDP 25-10 TA,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SENOKOT SYRUP,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
BETADINE SOLUTION 4O,6400014,CDM,250,RC,,,Outpatient,,,8.56,6.85,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.85,80,,5.48,percent of total billed charges,80% of total billed charges,3.19,37.27,,2.55,percent of total billed charges,37.27% of total billed charges,3.19,37.27,,2.55,percent of total billed charges,37.27% of total billed charges,3.19,37.27,,2.55,percent of total billed charges,37.27% 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,3.42,40,,2.74,percent of total billed charges,40% of total billed charges,3.19,6.85,
ROBITUSSIN 100MG/5ML,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
GUIATUSS DM SYRUP,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
REGLAN 5MG/ML VIAL,6065130,CDM,636,RC,J2765,HCPCS,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
ROBINUL 0.2MG/ML VIA,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
ROBINUL 0.2MG/ML VIA,6065130,CDM,636,RC,J1596,HCPCS,Outpatient,,,61.4,49.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.12,80,,39.3,percent of total billed charges,80% of total billed charges,22.88,37.27,,18.3,percent of total billed charges,37.27% of total billed charges,22.88,37.27,,18.3,percent of total billed charges,37.27% of total billed charges,22.88,37.27,,18.3,percent of total billed charges,37.27% 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,24.56,40,,19.65,percent of total billed charges,40% of total billed charges,22.88,49.12,
ADALAT CC 90MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,12.15,9.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.72,80,,7.78,percent of total billed charges,80% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% 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,4.86,40,,3.89,percent of total billed charges,40% of total billed charges,4.53,9.72,
CIPRO 250MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,23,18.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% 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,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,8.57,18.4,
NEO-SYNEPHRINE 0.25%,6400014,CDM,250,RC,,,Outpatient,,,11.52,9.22,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.22,80,,7.38,percent of total billed charges,80% of total billed charges,4.29,37.27,,3.43,percent of total billed charges,37.27% of total billed charges,4.29,37.27,,3.43,percent of total billed charges,37.27% of total billed charges,4.29,37.27,,3.43,percent of total billed charges,37.27% 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,4.61,40,,3.69,percent of total billed charges,40% of total billed charges,4.29,9.22,
CLEOCIN PHOS 150MG/M,6400014,CDM,250,RC,,,Outpatient,,,89.16,71.33,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.33,80,,57.06,percent of total billed charges,80% of total billed charges,33.23,37.27,,26.58,percent of total billed charges,37.27% of total billed charges,33.23,37.27,,26.58,percent of total billed charges,37.27% of total billed charges,33.23,37.27,,26.58,percent of total billed charges,37.27% 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,35.66,40,,28.53,percent of total billed charges,40% of total billed charges,33.23,71.33,
TETANUS TOXOID TUBEX,6400014,CDM,250,RC,,,Outpatient,,,75,60.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,80,,48,percent of total billed charges,80% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% 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,30,40,,24,percent of total billed charges,40% of total billed charges,27.95,60,
EFFEXOR 37.5MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,6.8,5.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,80,,4.35,percent of total billed charges,80% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% 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,2.72,40,,2.18,percent of total billed charges,40% of total billed charges,2.53,5.44,
CORDARONE 200MG TAB,6400014,CDM,250,RC,,,Outpatient,,,24.8,19.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.84,80,,15.87,percent of total billed charges,80% of total billed charges,9.24,37.27,,7.39,percent of total billed charges,37.27% of total billed charges,9.24,37.27,,7.39,percent of total billed charges,37.27% of total billed charges,9.24,37.27,,7.39,percent of total billed charges,37.27% 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,9.92,40,,7.94,percent of total billed charges,40% of total billed charges,9.24,19.84,
PNU-IMUNE 23 SYRINGE,6400014,CDM,250,RC,,,Outpatient,,,40.6,32.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.48,80,,25.98,percent of total billed charges,80% of total billed charges,15.13,37.27,,12.1,percent of total billed charges,37.27% of total billed charges,15.13,37.27,,12.1,percent of total billed charges,37.27% of total billed charges,15.13,37.27,,12.1,percent of total billed charges,37.27% 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,16.24,40,,12.99,percent of total billed charges,40% of total billed charges,15.13,32.48,
VASOTEC 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.3,2.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.64,80,,2.11,percent of total billed charges,80% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% 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,1.32,40,,1.06,percent of total billed charges,40% of total billed charges,1.23,2.64,
COZAAR 50MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,9.85,7.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.88,80,,6.3,percent of total billed charges,80% of total billed charges,3.67,37.27,,2.94,percent of total billed charges,37.27% of total billed charges,3.67,37.27,,2.94,percent of total billed charges,37.27% of total billed charges,3.67,37.27,,2.94,percent of total billed charges,37.27% 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,3.94,40,,3.15,percent of total billed charges,40% of total billed charges,3.67,7.88,
COZAAR 25MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,11.3,9.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.04,80,,7.23,percent of total billed charges,80% of total billed charges,4.21,37.27,,3.37,percent of total billed charges,37.27% of total billed charges,4.21,37.27,,3.37,percent of total billed charges,37.27% of total billed charges,4.21,37.27,,3.37,percent of total billed charges,37.27% 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,4.52,40,,3.62,percent of total billed charges,40% of total billed charges,4.21,9.04,
TIMOPTIC 0.5% EYE DR,6400014,CDM,250,RC,,,Outpatient,,,57.95,46.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.36,80,,37.09,percent of total billed charges,80% of total billed charges,21.6,37.27,,17.28,percent of total billed charges,37.27% of total billed charges,21.6,37.27,,17.28,percent of total billed charges,37.27% of total billed charges,21.6,37.27,,17.28,percent of total billed charges,37.27% 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,23.18,40,,18.54,percent of total billed charges,40% of total billed charges,21.6,46.36,
TIMOPTIC-XE 0.5% EYE,6400014,CDM,250,RC,,,Outpatient,,,50,40.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
COREG 6.25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,7.8,6.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.24,80,,4.99,percent of total billed charges,80% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% 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,3.12,40,,2.5,percent of total billed charges,40% of total billed charges,2.91,6.24,
LORAZEPAM 2MG/ML VIA,6065130,CDM,636,RC,J2060,HCPCS,Outpatient,,,13.1,10.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.48,80,,8.38,percent of total billed charges,80% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% 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,5.24,40,,4.19,percent of total billed charges,40% of total billed charges,4.88,10.48,
SALIVA SUBSTITUTE SO,6400014,CDM,250,RC,,,Outpatient,,,27.36,21.89,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.89,80,,17.51,percent of total billed charges,80% of total billed charges,10.2,37.27,,8.16,percent of total billed charges,37.27% of total billed charges,10.2,37.27,,8.16,percent of total billed charges,37.27% of total billed charges,10.2,37.27,,8.16,percent of total billed charges,37.27% 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,10.94,40,,8.75,percent of total billed charges,40% of total billed charges,10.2,21.89,
PHILLIPS' MOM TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
MAG-OX 400 TAB UD,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
MAG-TAB SR 84MG CAP,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
STRESS W/IRON TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
SORBITRATE 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SORBITRATE 40MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SORBITRATE 40MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
D5W 1000ML/KCL 20MEQ,5753355,CDM,258,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
TRAMDATE 200MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SYNTHROID 100MCG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SYNTHROID 150MCG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SYNTHROID 200MCG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SYNTHROID 75MCG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
XYLOCAINE-MPF 1% AMP,6400014,CDM,250,RC,,,Outpatient,,,27.45,21.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.96,80,,17.57,percent of total billed charges,80% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% 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,10.98,40,,8.78,percent of total billed charges,40% of total billed charges,10.23,21.96,
XYLOCAINE-MPF 1% AMP,6400014,CDM,250,RC,,,Outpatient,,,27.45,21.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.96,80,,17.57,percent of total billed charges,80% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% 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,10.98,40,,8.78,percent of total billed charges,40% of total billed charges,10.23,21.96,
LINDANE 1% LOTION,6400014,CDM,250,RC,,,Outpatient,,,26.4,21.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,80,,16.9,percent of total billed charges,80% of total billed charges,9.84,37.27,,7.87,percent of total billed charges,37.27% of total billed charges,9.84,37.27,,7.87,percent of total billed charges,37.27% of total billed charges,9.84,37.27,,7.87,percent of total billed charges,37.27% 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,10.56,40,,8.45,percent of total billed charges,40% of total billed charges,9.84,21.12,
LINDANE 1% SHAMPOO,6400014,CDM,250,RC,,,Outpatient,,,26.4,21.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,80,,16.9,percent of total billed charges,80% of total billed charges,9.84,37.27,,7.87,percent of total billed charges,37.27% of total billed charges,9.84,37.27,,7.87,percent of total billed charges,37.27% of total billed charges,9.84,37.27,,7.87,percent of total billed charges,37.27% 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,10.56,40,,8.45,percent of total billed charges,40% of total billed charges,9.84,21.12,
SPECTZOLE CREAM 1% 1,6400014,CDM,250,RC,,,Outpatient,,,316.45,253.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,253.16,80,,202.53,percent of total billed charges,80% of total billed charges,117.94,37.27,,94.35,percent of total billed charges,37.27% of total billed charges,117.94,37.27,,94.35,percent of total billed charges,37.27% of total billed charges,117.94,37.27,,94.35,percent of total billed charges,37.27% 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,126.58,40,,101.26,percent of total billed charges,40% of total billed charges,117.94,253.16,
ALPRAZOLAM .50MG U/D,6400014,CDM,250,RC,,,Outpatient,,,3.35,2.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.68,80,,2.14,percent of total billed charges,80% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% of total billed charges,1.25,37.27,,1,percent of total billed charges,37.27% 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,1.34,40,,1.07,percent of total billed charges,40% of total billed charges,1.25,2.68,
TALACEN TABLETS,6400014,CDM,250,RC,,,Outpatient,,,6.15,4.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.92,80,,3.94,percent of total billed charges,80% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% 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,2.46,40,,1.97,percent of total billed charges,40% of total billed charges,2.29,4.92,
DOBUTAMINE 250MG/20M,6065130,CDM,636,RC,J1250,HCPCS,Outpatient,,,142.4,113.92,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,113.92,80,,91.14,percent of total billed charges,80% of total billed charges,53.07,37.27,,42.46,percent of total billed charges,37.27% of total billed charges,53.07,37.27,,42.46,percent of total billed charges,37.27% of total billed charges,53.07,37.27,,42.46,percent of total billed charges,37.27% 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,56.96,40,,45.57,percent of total billed charges,40% of total billed charges,53.07,113.92,
MECLIZINEN 25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
MICARDIS 40MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,22.05,17.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.64,80,,14.11,percent of total billed charges,80% of total billed charges,8.22,37.27,,6.58,percent of total billed charges,37.27% of total billed charges,8.22,37.27,,6.58,percent of total billed charges,37.27% of total billed charges,8.22,37.27,,6.58,percent of total billed charges,37.27% 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,8.82,40,,7.06,percent of total billed charges,40% of total billed charges,8.22,17.64,
SOD.BICARB 4.2% 10CC,6400014,CDM,250,RC,,,Outpatient,,,82.3,65.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.84,80,,52.67,percent of total billed charges,80% of total billed charges,30.67,37.27,,24.54,percent of total billed charges,37.27% of total billed charges,30.67,37.27,,24.54,percent of total billed charges,37.27% of total billed charges,30.67,37.27,,24.54,percent of total billed charges,37.27% 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,32.92,40,,26.34,percent of total billed charges,40% of total billed charges,30.67,65.84,
PHOSLO TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ALPRAZOLAM .25MG U/D,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
SANDIMMUNE 25MG CAPS,6065130,CDM,636,RC,J7515,HCPCS,Outpatient,,,4.65,3.72,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.72,80,,2.98,percent of total billed charges,80% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% 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,1.86,40,,1.49,percent of total billed charges,40% of total billed charges,1.73,3.72,
DIOVAN HCT 80/12.5MG,6400014,CDM,250,RC,,,Outpatient,,,11.85,9.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.48,80,,7.58,percent of total billed charges,80% of total billed charges,4.42,37.27,,3.54,percent of total billed charges,37.27% of total billed charges,4.42,37.27,,3.54,percent of total billed charges,37.27% of total billed charges,4.42,37.27,,3.54,percent of total billed charges,37.27% 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,4.74,40,,3.79,percent of total billed charges,40% of total billed charges,4.42,9.48,
OMNICEF 300MG OMNI-P,6400014,CDM,250,RC,,,Outpatient,,,30.2,24.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.16,80,,19.33,percent of total billed charges,80% of total billed charges,11.26,37.27,,9.01,percent of total billed charges,37.27% of total billed charges,11.26,37.27,,9.01,percent of total billed charges,37.27% of total billed charges,11.26,37.27,,9.01,percent of total billed charges,37.27% 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,12.08,40,,9.66,percent of total billed charges,40% of total billed charges,11.26,24.16,
GEODON 20MG CAP,6400014,CDM,250,RC,,,Outpatient,,,33.9,27.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.12,80,,21.7,percent of total billed charges,80% of total billed charges,12.63,37.27,,10.1,percent of total billed charges,37.27% of total billed charges,12.63,37.27,,10.1,percent of total billed charges,37.27% of total billed charges,12.63,37.27,,10.1,percent of total billed charges,37.27% 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,13.56,40,,10.85,percent of total billed charges,40% of total billed charges,12.63,27.12,
NEPHRO-VITE RX TAB,6400014,CDM,250,RC,,,Outpatient,,,1.75,1.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.4,80,,1.12,percent of total billed charges,80% of total billed charges,0.65,37.27,,0.52,percent of total billed charges,37.27% of total billed charges,0.65,37.27,,0.52,percent of total billed charges,37.27% of total billed charges,0.65,37.27,,0.52,percent of total billed charges,37.27% 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,0.7,40,,0.56,percent of total billed charges,40% of total billed charges,0.65,1.4,
HOMATROPINE 2% OPHTH,6400014,CDM,250,RC,,,Outpatient,,,34.65,27.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.72,80,,22.18,percent of total billed charges,80% of total billed charges,12.91,37.27,,10.33,percent of total billed charges,37.27% of total billed charges,12.91,37.27,,10.33,percent of total billed charges,37.27% of total billed charges,12.91,37.27,,10.33,percent of total billed charges,37.27% 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,13.86,40,,11.09,percent of total billed charges,40% of total billed charges,12.91,27.72,
WELLBUTRIN XL 150MG,6400014,CDM,250,RC,,,Outpatient,,,22.65,18.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.12,80,,14.5,percent of total billed charges,80% of total billed charges,8.44,37.27,,6.75,percent of total billed charges,37.27% of total billed charges,8.44,37.27,,6.75,percent of total billed charges,37.27% of total billed charges,8.44,37.27,,6.75,percent of total billed charges,37.27% 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,9.06,40,,7.25,percent of total billed charges,40% of total billed charges,8.44,18.12,
COLESTID 5 GRAM PACK,6400014,CDM,250,RC,,,Outpatient,,,4.45,3.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.56,80,,2.85,percent of total billed charges,80% of total billed charges,1.66,37.27,,1.33,percent of total billed charges,37.27% of total billed charges,1.66,37.27,,1.33,percent of total billed charges,37.27% of total billed charges,1.66,37.27,,1.33,percent of total billed charges,37.27% 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,1.78,40,,1.42,percent of total billed charges,40% of total billed charges,1.66,3.56,
CALCIUM CHLORIDE 1GM,6400014,CDM,250,RC,,,Outpatient,,,79.05,63.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.24,80,,50.59,percent of total billed charges,80% of total billed charges,29.46,37.27,,23.57,percent of total billed charges,37.27% of total billed charges,29.46,37.27,,23.57,percent of total billed charges,37.27% of total billed charges,29.46,37.27,,23.57,percent of total billed charges,37.27% 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,31.62,40,,25.3,percent of total billed charges,40% of total billed charges,29.46,63.24,
GELFOAM SPONGE 100,5880901,CDM,637,RC,,,Outpatient,,,150.14,120.11,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.11,80,,96.09,percent of total billed charges,80% of total billed charges,55.96,37.27,,44.77,percent of total billed charges,37.27% of total billed charges,55.96,37.27,,44.77,percent of total billed charges,37.27% of total billed charges,55.96,37.27,,44.77,percent of total billed charges,37.27% 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,60.06,40,,48.05,percent of total billed charges,40% of total billed charges,55.96,120.11,
PRIMAXIN :500MG IV,6065130,CDM,636,RC,J0743,HCPCS,Outpatient,,,134.65,107.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.72,80,,86.18,percent of total billed charges,80% of total billed charges,50.18,37.27,,40.14,percent of total billed charges,37.27% of total billed charges,50.18,37.27,,40.14,percent of total billed charges,37.27% of total billed charges,50.18,37.27,,40.14,percent of total billed charges,37.27% 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,53.86,40,,43.09,percent of total billed charges,40% of total billed charges,50.18,107.72,
DICYCLOMINE 10MG CAP,6400014,CDM,250,RC,,,Outpatient,,,2.3,1.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.84,80,,1.47,percent of total billed charges,80% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% 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,0.92,40,,0.74,percent of total billed charges,40% of total billed charges,0.86,1.84,
CLIMARA 0.05MCG/DAY,6400014,CDM,250,RC,,,Outpatient,,,18.08,14.46,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.46,80,,11.57,percent of total billed charges,80% of total billed charges,6.74,37.27,,5.39,percent of total billed charges,37.27% of total billed charges,6.74,37.27,,5.39,percent of total billed charges,37.27% of total billed charges,6.74,37.27,,5.39,percent of total billed charges,37.27% 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,7.23,40,,5.78,percent of total billed charges,40% of total billed charges,6.74,14.46,
ZITHROMAX 500MG,6400014,CDM,250,RC,J0456,HCPCS,Outpatient,,,112.6,90.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.08,80,,72.06,percent of total billed charges,80% of total billed charges,41.97,37.27,,33.58,percent of total billed charges,37.27% of total billed charges,41.97,37.27,,33.58,percent of total billed charges,37.27% of total billed charges,41.97,37.27,,33.58,percent of total billed charges,37.27% 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,45.04,40,,36.03,percent of total billed charges,40% of total billed charges,41.97,90.08,
ULTRAM 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.95,2.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,80,,1.89,percent of total billed charges,80% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% 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,1.18,40,,0.94,percent of total billed charges,40% of total billed charges,1.1,2.36,
CHLORHEXIDINE 0.12%,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
TOBREX 0.3% OPHTH SO,6400014,CDM,250,RC,,,Outpatient,,,50.1,40.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.08,80,,32.06,percent of total billed charges,80% of total billed charges,18.67,37.27,,14.94,percent of total billed charges,37.27% of total billed charges,18.67,37.27,,14.94,percent of total billed charges,37.27% of total billed charges,18.67,37.27,,14.94,percent of total billed charges,37.27% 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,20.04,40,,16.03,percent of total billed charges,40% of total billed charges,18.67,40.08,
"VITAMIN D 50,000",6400014,CDM,250,RC,,,Outpatient,,,6.5,5.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.2,80,,4.16,percent of total billed charges,80% of total billed charges,2.42,37.27,,1.94,percent of total billed charges,37.27% of total billed charges,2.42,37.27,,1.94,percent of total billed charges,37.27% of total billed charges,2.42,37.27,,1.94,percent of total billed charges,37.27% 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,2.6,40,,2.08,percent of total billed charges,40% of total billed charges,2.42,5.2,
NEOSPORIN OPTH OINT,6400014,CDM,250,RC,,,Outpatient,,,191.8,153.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.44,80,,122.75,percent of total billed charges,80% of total billed charges,71.48,37.27,,57.18,percent of total billed charges,37.27% of total billed charges,71.48,37.27,,57.18,percent of total billed charges,37.27% of total billed charges,71.48,37.27,,57.18,percent of total billed charges,37.27% 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,76.72,40,,61.38,percent of total billed charges,40% of total billed charges,71.48,153.44,
EMPLOYEE MEDS,6466668,CDM,999,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
SELSUN LOTION,5828504,CDM,990,RC,,,Outpatient,,,44.85,35.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.88,80,,28.7,percent of total billed charges,80% of total billed charges,16.72,37.27,,13.38,percent of total billed charges,37.27% of total billed charges,16.72,37.27,,13.38,percent of total billed charges,37.27% of total billed charges,16.72,37.27,,13.38,percent of total billed charges,37.27% 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,17.94,40,,14.35,percent of total billed charges,40% of total billed charges,16.72,35.88,
UROQID ACID #2 TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
SILVADENE CR 20 GM,6400014,CDM,250,RC,,,Outpatient,,,14.35,11.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.48,80,,9.18,percent of total billed charges,80% of total billed charges,5.35,37.27,,4.28,percent of total billed charges,37.27% of total billed charges,5.35,37.27,,4.28,percent of total billed charges,37.27% of total billed charges,5.35,37.27,,4.28,percent of total billed charges,37.27% 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,5.74,40,,4.59,percent of total billed charges,40% of total billed charges,5.35,11.48,
BIAXIN-250MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,9.2,7.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,80,,5.89,percent of total billed charges,80% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% 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,3.68,40,,2.94,percent of total billed charges,40% of total billed charges,3.43,7.36,
ELDEPRYL 5MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,9.8,7.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.84,80,,6.27,percent of total billed charges,80% of total billed charges,3.65,37.27,,2.92,percent of total billed charges,37.27% of total billed charges,3.65,37.27,,2.92,percent of total billed charges,37.27% of total billed charges,3.65,37.27,,2.92,percent of total billed charges,37.27% 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,3.92,40,,3.14,percent of total billed charges,40% of total billed charges,3.65,7.84,
QUININE 5 GR,6400014,CDM,250,RC,,,Outpatient,,,3.05,2.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.44,80,,1.95,percent of total billed charges,80% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% 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,1.22,40,,0.98,percent of total billed charges,40% of total billed charges,1.14,2.44,
CATAPRES TTS-3 PER P,6400014,CDM,250,RC,,,Outpatient,,,197.35,157.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.88,80,,126.3,percent of total billed charges,80% of total billed charges,73.55,37.27,,58.84,percent of total billed charges,37.27% of total billed charges,73.55,37.27,,58.84,percent of total billed charges,37.27% of total billed charges,73.55,37.27,,58.84,percent of total billed charges,37.27% 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,78.94,40,,63.15,percent of total billed charges,40% of total billed charges,73.55,157.88,
TOBREX OPTH OINT,6400014,CDM,250,RC,,,Outpatient,,,889.7,711.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,711.76,80,,569.41,percent of total billed charges,80% of total billed charges,331.59,37.27,,265.27,percent of total billed charges,37.27% of total billed charges,331.59,37.27,,265.27,percent of total billed charges,37.27% of total billed charges,331.59,37.27,,265.27,percent of total billed charges,37.27% 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,355.88,40,,284.7,percent of total billed charges,40% of total billed charges,331.59,711.76,
ZAROXOLYN TAB 5MG U/,6400014,CDM,250,RC,,,Outpatient,,,8,6.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
MARCAINE INJ 0.5% 10,6400014,CDM,250,RC,,,Outpatient,,,37.76,30.21,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.21,80,,24.17,percent of total billed charges,80% of total billed charges,14.07,37.27,,11.26,percent of total billed charges,37.27% of total billed charges,14.07,37.27,,11.26,percent of total billed charges,37.27% of total billed charges,14.07,37.27,,11.26,percent of total billed charges,37.27% 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,15.1,40,,12.08,percent of total billed charges,40% of total billed charges,14.07,30.21,
AMIODARONE INJ 150MG,6065130,CDM,636,RC,J0282,HCPCS,Outpatient,,,13.95,11.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.16,80,,8.93,percent of total billed charges,80% of total billed charges,5.2,37.27,,4.16,percent of total billed charges,37.27% of total billed charges,5.2,37.27,,4.16,percent of total billed charges,37.27% of total billed charges,5.2,37.27,,4.16,percent of total billed charges,37.27% 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,5.58,40,,4.46,percent of total billed charges,40% of total billed charges,5.2,11.16,
CERVIDIL 10 MG,6400014,CDM,250,RC,,,Outpatient,,,684.5,547.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,547.6,80,,438.08,percent of total billed charges,80% of total billed charges,255.11,37.27,,204.09,percent of total billed charges,37.27% of total billed charges,255.11,37.27,,204.09,percent of total billed charges,37.27% of total billed charges,255.11,37.27,,204.09,percent of total billed charges,37.27% 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,273.8,40,,219.04,percent of total billed charges,40% of total billed charges,255.11,547.6,
BOTOX INJ 100U,6065130,CDM,636,RC,J0585,HCPCS,Outpatient,,,23.33,18.66,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.66,80,,14.93,percent of total billed charges,80% of total billed charges,8.7,37.27,,6.96,percent of total billed charges,37.27% of total billed charges,8.7,37.27,,6.96,percent of total billed charges,37.27% of total billed charges,8.7,37.27,,6.96,percent of total billed charges,37.27% of total billed charges,6.41,100,,,fee schedule,100% of APC rate,6.41,100,,,fee schedule,100% of APC rate,6.41,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,6.41,100,,,fee schedule,100% of APC rate,6.41,100,,,fee schedule,100% of APC rate,6.41,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.33,40,,7.46,percent of total billed charges,40% of total billed charges,6.41,18.66,
LORAZEPAM TAB 1MG,6400014,CDM,250,RC,,,Outpatient,,,3.15,2.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,80,,2.02,percent of total billed charges,80% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% 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,1.26,40,,1.01,percent of total billed charges,40% of total billed charges,1.17,2.52,
ISOSORBIDE DINITRATE,6400014,CDM,250,RC,,,Outpatient,,,8.45,6.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.76,80,,5.41,percent of total billed charges,80% of total billed charges,3.15,37.27,,2.52,percent of total billed charges,37.27% of total billed charges,3.15,37.27,,2.52,percent of total billed charges,37.27% of total billed charges,3.15,37.27,,2.52,percent of total billed charges,37.27% 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,3.38,40,,2.7,percent of total billed charges,40% of total billed charges,3.15,6.76,
DOSYCYCLINE HYCLATE,6400014,CDM,250,RC,,,Outpatient,,,18.4,14.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,80,,11.78,percent of total billed charges,80% of total billed charges,6.86,37.27,,5.49,percent of total billed charges,37.27% of total billed charges,6.86,37.27,,5.49,percent of total billed charges,37.27% of total billed charges,6.86,37.27,,5.49,percent of total billed charges,37.27% 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,7.36,40,,5.89,percent of total billed charges,40% of total billed charges,6.86,14.72,
ENSURE HIGH PROTEIN,6400014,CDM,250,RC,,,Outpatient,,,6.6,5.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.28,80,,4.22,percent of total billed charges,80% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% 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,2.64,40,,2.11,percent of total billed charges,40% of total billed charges,2.46,5.28,
IV NS 500ML LATEX FR,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
CALCIUM CITRATE 950M,6400014,CDM,250,RC,,,Outpatient,,,1,0.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,80,,0.64,percent of total billed charges,80% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% 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,0.4,40,,0.32,percent of total billed charges,40% of total billed charges,0.37,0.8,
DEXTRAN-40 500ML,6065130,CDM,636,RC,J7100,HCPCS,Outpatient,,,118.8,95.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.04,80,,76.03,percent of total billed charges,80% of total billed charges,44.28,37.27,,35.42,percent of total billed charges,37.27% of total billed charges,44.28,37.27,,35.42,percent of total billed charges,37.27% of total billed charges,44.28,37.27,,35.42,percent of total billed charges,37.27% 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,47.52,40,,38.02,percent of total billed charges,40% of total billed charges,44.28,95.04,
RIFADIN IV 600MG,6400014,CDM,250,RC,,,Outpatient,,,730.65,584.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,584.52,80,,467.62,percent of total billed charges,80% of total billed charges,272.31,37.27,,217.85,percent of total billed charges,37.27% of total billed charges,272.31,37.27,,217.85,percent of total billed charges,37.27% of total billed charges,272.31,37.27,,217.85,percent of total billed charges,37.27% 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,292.26,40,,233.81,percent of total billed charges,40% of total billed charges,272.31,584.52,
VIOXX 12.5MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,6.67,5.34,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.34,80,,4.27,percent of total billed charges,80% of total billed charges,2.49,37.27,,1.99,percent of total billed charges,37.27% of total billed charges,2.49,37.27,,1.99,percent of total billed charges,37.27% of total billed charges,2.49,37.27,,1.99,percent of total billed charges,37.27% 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,2.67,40,,2.14,percent of total billed charges,40% of total billed charges,2.49,5.34,
FLUPHENAZINE 10MG (P,6400014,CDM,250,RC,,,Outpatient,,,3.93,3.14,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.14,80,,2.51,percent of total billed charges,80% of total billed charges,1.46,37.27,,1.17,percent of total billed charges,37.27% of total billed charges,1.46,37.27,,1.17,percent of total billed charges,37.27% of total billed charges,1.46,37.27,,1.17,percent of total billed charges,37.27% 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,1.57,40,,1.26,percent of total billed charges,40% of total billed charges,1.46,3.14,
ACTOS 30MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,40.55,32.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.44,80,,25.95,percent of total billed charges,80% of total billed charges,15.11,37.27,,12.09,percent of total billed charges,37.27% of total billed charges,15.11,37.27,,12.09,percent of total billed charges,37.27% of total billed charges,15.11,37.27,,12.09,percent of total billed charges,37.27% 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,16.22,40,,12.98,percent of total billed charges,40% of total billed charges,15.11,32.44,
PCA BAG HYDROMORPH 0,6400014,CDM,250,RC,,,Outpatient,,,202.92,162.34,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.34,80,,129.87,percent of total billed charges,80% of total billed charges,75.63,37.27,,60.5,percent of total billed charges,37.27% of total billed charges,75.63,37.27,,60.5,percent of total billed charges,37.27% of total billed charges,75.63,37.27,,60.5,percent of total billed charges,37.27% 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,81.17,40,,64.94,percent of total billed charges,40% of total billed charges,75.63,162.34,
PCA MERPERIDINE BAG,6400014,CDM,250,RC,,,Outpatient,,,154.92,123.94,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.94,80,,99.15,percent of total billed charges,80% of total billed charges,57.74,37.27,,46.19,percent of total billed charges,37.27% of total billed charges,57.74,37.27,,46.19,percent of total billed charges,37.27% of total billed charges,57.74,37.27,,46.19,percent of total billed charges,37.27% 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,61.97,40,,49.58,percent of total billed charges,40% of total billed charges,57.74,123.94,
PCA MORPHINE BAG 1MG,6400014,CDM,250,RC,,,Outpatient,,,162.96,130.37,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.37,80,,104.3,percent of total billed charges,80% of total billed charges,60.74,37.27,,48.59,percent of total billed charges,37.27% of total billed charges,60.74,37.27,,48.59,percent of total billed charges,37.27% of total billed charges,60.74,37.27,,48.59,percent of total billed charges,37.27% 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,65.18,40,,52.14,percent of total billed charges,40% of total billed charges,60.74,130.37,
ANECTINE 20 MG/ML,6065130,CDM,636,RC,J0330,HCPCS,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
VIOXX 25MG TABLETS,6400014,CDM,250,RC,,,Outpatient,,,8.33,6.66,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.66,80,,5.33,percent of total billed charges,80% of total billed charges,3.1,37.27,,2.48,percent of total billed charges,37.27% of total billed charges,3.1,37.27,,2.48,percent of total billed charges,37.27% of total billed charges,3.1,37.27,,2.48,percent of total billed charges,37.27% 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,3.33,40,,2.66,percent of total billed charges,40% of total billed charges,3.1,6.66,
ADVAIR DISKUS 100/50,6400014,CDM,250,RC,,,Outpatient,,,475.2,380.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380.16,80,,304.13,percent of total billed charges,80% of total billed charges,177.11,37.27,,141.69,percent of total billed charges,37.27% of total billed charges,177.11,37.27,,141.69,percent of total billed charges,37.27% of total billed charges,177.11,37.27,,141.69,percent of total billed charges,37.27% 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,190.08,40,,152.06,percent of total billed charges,40% of total billed charges,177.11,380.16,
DURICEF CAPSULE 500M,6400014,CDM,250,RC,,,Outpatient,,,15.4,12.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.32,80,,9.86,percent of total billed charges,80% of total billed charges,5.74,37.27,,4.59,percent of total billed charges,37.27% of total billed charges,5.74,37.27,,4.59,percent of total billed charges,37.27% of total billed charges,5.74,37.27,,4.59,percent of total billed charges,37.27% 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,6.16,40,,4.93,percent of total billed charges,40% of total billed charges,5.74,12.32,
RELAFEN 500MG TAB,6400014,CDM,250,RC,,,Outpatient,,,7.3,5.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.84,80,,4.67,percent of total billed charges,80% of total billed charges,2.72,37.27,,2.18,percent of total billed charges,37.27% of total billed charges,2.72,37.27,,2.18,percent of total billed charges,37.27% of total billed charges,2.72,37.27,,2.18,percent of total billed charges,37.27% 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,2.92,40,,2.34,percent of total billed charges,40% of total billed charges,2.72,5.84,
TORADOL 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,4.2,3.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.36,80,,2.69,percent of total billed charges,80% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% 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,1.68,40,,1.34,percent of total billed charges,40% of total billed charges,1.57,3.36,
RHEUMATREX 2.5MG,6400014,CDM,250,RC,,,Outpatient,,,13.45,10.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.76,80,,8.61,percent of total billed charges,80% of total billed charges,5.01,37.27,,4.01,percent of total billed charges,37.27% of total billed charges,5.01,37.27,,4.01,percent of total billed charges,37.27% of total billed charges,5.01,37.27,,4.01,percent of total billed charges,37.27% 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,5.38,40,,4.3,percent of total billed charges,40% of total billed charges,5.01,10.76,
AXID 150MG CAP U/D,6400014,CDM,250,RC,,,Outpatient,,,5.35,4.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.28,80,,3.42,percent of total billed charges,80% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% 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,2.14,40,,1.71,percent of total billed charges,40% of total billed charges,1.99,4.28,
MICATIN 1OZ CREAM,6400014,CDM,250,RC,,,Outpatient,,,31.35,25.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.08,80,,20.06,percent of total billed charges,80% of total billed charges,11.68,37.27,,9.34,percent of total billed charges,37.27% of total billed charges,11.68,37.27,,9.34,percent of total billed charges,37.27% of total billed charges,11.68,37.27,,9.34,percent of total billed charges,37.27% 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,12.54,40,,10.03,percent of total billed charges,40% of total billed charges,11.68,25.08,
BUFFERED ASPIRIN,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
TYLENOL CHILDREN LIQ,6400014,CDM,250,RC,,,Outpatient,,,11.95,9.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.56,80,,7.65,percent of total billed charges,80% of total billed charges,4.45,37.27,,3.56,percent of total billed charges,37.27% of total billed charges,4.45,37.27,,3.56,percent of total billed charges,37.27% of total billed charges,4.45,37.27,,3.56,percent of total billed charges,37.27% 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,4.78,40,,3.82,percent of total billed charges,40% of total billed charges,4.45,9.56,
TYLENOL INFANT DROPS,6400014,CDM,250,RC,,,Outpatient,,,14.85,11.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.88,80,,9.5,percent of total billed charges,80% of total billed charges,5.53,37.27,,4.42,percent of total billed charges,37.27% of total billed charges,5.53,37.27,,4.42,percent of total billed charges,37.27% of total billed charges,5.53,37.27,,4.42,percent of total billed charges,37.27% 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,5.94,40,,4.75,percent of total billed charges,40% of total billed charges,5.53,11.88,
ROBITUSSIN AC 5 ML,6400014,CDM,250,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
GUIATUSS EXP 5ML,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
GUIATUSS DM 5ML,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
DIMETAPP ELIXIR,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
DONNATLA ELIXIR 5 ML,6400014,CDM,250,RC,,,Outpatient,,,37.6,30.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,80,,24.06,percent of total billed charges,80% of total billed charges,14.01,37.27,,11.21,percent of total billed charges,37.27% of total billed charges,14.01,37.27,,11.21,percent of total billed charges,37.27% of total billed charges,14.01,37.27,,11.21,percent of total billed charges,37.27% 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,15.04,40,,12.03,percent of total billed charges,40% of total billed charges,14.01,30.08,
PHENERGAN VC 5ML,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
DEXAMETHASONE ELIX.0,6400014,CDM,250,RC,,,Outpatient,,,4.65,3.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.72,80,,2.98,percent of total billed charges,80% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% 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,1.86,40,,1.49,percent of total billed charges,40% of total billed charges,1.73,3.72,
PHENOBARBITAL ELIXIR,6400014,CDM,250,RC,,,Outpatient,,,19.85,15.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.88,80,,12.7,percent of total billed charges,80% of total billed charges,7.4,37.27,,5.92,percent of total billed charges,37.27% of total billed charges,7.4,37.27,,5.92,percent of total billed charges,37.27% of total billed charges,7.4,37.27,,5.92,percent of total billed charges,37.27% 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,7.94,40,,6.35,percent of total billed charges,40% of total billed charges,7.4,15.88,
PRINZIDE 10-12.5,6400014,CDM,250,RC,,,Outpatient,,,3.75,3.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,80,,2.4,percent of total billed charges,80% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% 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,1.5,40,,1.2,percent of total billed charges,40% of total billed charges,1.4,3,
TYLENOL W/CODEINE,6400014,CDM,250,RC,,,Outpatient,,,1.9,1.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.52,80,,1.22,percent of total billed charges,80% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% 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,0.76,40,,0.61,percent of total billed charges,40% of total billed charges,0.71,1.52,
CIPRO IV 400MG,6065130,CDM,636,RC,J0744,HCPCS,Outpatient,,,150.5,120.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.4,80,,96.32,percent of total billed charges,80% of total billed charges,56.09,37.27,,44.87,percent of total billed charges,37.27% of total billed charges,56.09,37.27,,44.87,percent of total billed charges,37.27% of total billed charges,56.09,37.27,,44.87,percent of total billed charges,37.27% 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,60.2,40,,48.16,percent of total billed charges,40% of total billed charges,56.09,120.4,
HYDROCORTISONE CR 1%,6400014,CDM,250,RC,,,Outpatient,,,16.35,13.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.08,80,,10.46,percent of total billed charges,80% of total billed charges,6.09,37.27,,4.87,percent of total billed charges,37.27% of total billed charges,6.09,37.27,,4.87,percent of total billed charges,37.27% of total billed charges,6.09,37.27,,4.87,percent of total billed charges,37.27% 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,6.54,40,,5.23,percent of total billed charges,40% of total billed charges,6.09,13.08,
METRONIDAZOLE 250MG,6400014,CDM,250,RC,,,Outpatient,,,1.95,1.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.56,80,,1.25,percent of total billed charges,80% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% 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,0.78,40,,0.62,percent of total billed charges,40% of total billed charges,0.73,1.56,
DILANTIN INJ 250MG/5,6065130,CDM,636,RC,J1165,HCPCS,Outpatient,,,22.65,18.12,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.12,80,,14.5,percent of total billed charges,80% of total billed charges,8.44,37.27,,6.75,percent of total billed charges,37.27% of total billed charges,8.44,37.27,,6.75,percent of total billed charges,37.27% of total billed charges,8.44,37.27,,6.75,percent of total billed charges,37.27% 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,9.06,40,,7.25,percent of total billed charges,40% of total billed charges,8.44,18.12,
ATROVENT NASAL SPRAY,6400014,CDM,250,RC,,,Outpatient,,,249.8,199.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.84,80,,159.87,percent of total billed charges,80% of total billed charges,93.1,37.27,,74.48,percent of total billed charges,37.27% of total billed charges,93.1,37.27,,74.48,percent of total billed charges,37.27% of total billed charges,93.1,37.27,,74.48,percent of total billed charges,37.27% 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,99.92,40,,79.94,percent of total billed charges,40% of total billed charges,93.1,199.84,
METOCLOPRAMIDE 5MG/M,6065130,CDM,636,RC,J2765,HCPCS,Outpatient,,,5.7,4.56,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.56,80,,3.65,percent of total billed charges,80% of total billed charges,2.12,37.27,,1.7,percent of total billed charges,37.27% of total billed charges,2.12,37.27,,1.7,percent of total billed charges,37.27% of total billed charges,2.12,37.27,,1.7,percent of total billed charges,37.27% 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,2.28,40,,1.82,percent of total billed charges,40% of total billed charges,2.12,4.56,
ANACAND 16MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,14.5,11.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.6,80,,9.28,percent of total billed charges,80% of total billed charges,5.4,37.27,,4.32,percent of total billed charges,37.27% of total billed charges,5.4,37.27,,4.32,percent of total billed charges,37.27% of total billed charges,5.4,37.27,,4.32,percent of total billed charges,37.27% 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,5.8,40,,4.64,percent of total billed charges,40% of total billed charges,5.4,11.6,
TEGRETOL XR 100MG TA,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
DEXAMETHASONE 10MG/M,6400014,CDM,250,RC,,,Outpatient,,,12.7,10.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
PRINIVIL 20MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,3.08,2.46,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.46,80,,1.97,percent of total billed charges,80% of total billed charges,1.15,37.27,,0.92,percent of total billed charges,37.27% of total billed charges,1.15,37.27,,0.92,percent of total billed charges,37.27% of total billed charges,1.15,37.27,,0.92,percent of total billed charges,37.27% 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,1.23,40,,0.98,percent of total billed charges,40% of total billed charges,1.15,2.46,
TOPAMAX 25MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,26.8,21.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,80,,17.15,percent of total billed charges,80% of total billed charges,9.99,37.27,,7.99,percent of total billed charges,37.27% of total billed charges,9.99,37.27,,7.99,percent of total billed charges,37.27% of total billed charges,9.99,37.27,,7.99,percent of total billed charges,37.27% 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,10.72,40,,8.58,percent of total billed charges,40% of total billed charges,9.99,21.44,
ZYRTEC 1MG/ML SYRUP,6400014,CDM,250,RC,,,Outpatient,,,33.4,26.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.72,80,,21.38,percent of total billed charges,80% of total billed charges,12.45,37.27,,9.96,percent of total billed charges,37.27% of total billed charges,12.45,37.27,,9.96,percent of total billed charges,37.27% of total billed charges,12.45,37.27,,9.96,percent of total billed charges,37.27% 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,13.36,40,,10.69,percent of total billed charges,40% of total billed charges,12.45,26.72,
TEQUIN 400MG TAB,6400014,CDM,250,RC,,,Outpatient,,,26.58,21.26,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.26,80,,17.01,percent of total billed charges,80% of total billed charges,9.91,37.27,,7.93,percent of total billed charges,37.27% of total billed charges,9.91,37.27,,7.93,percent of total billed charges,37.27% of total billed charges,9.91,37.27,,7.93,percent of total billed charges,37.27% 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,10.63,40,,8.5,percent of total billed charges,40% of total billed charges,9.91,21.26,
TAMIFLU 75MG CAP,6400014,CDM,250,RC,,,Outpatient,,,71.25,57.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57,80,,45.6,percent of total billed charges,80% of total billed charges,26.55,37.27,,21.24,percent of total billed charges,37.27% of total billed charges,26.55,37.27,,21.24,percent of total billed charges,37.27% of total billed charges,26.55,37.27,,21.24,percent of total billed charges,37.27% 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,28.5,40,,22.8,percent of total billed charges,40% of total billed charges,26.55,57,
PLETAL 100MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,7.35,5.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.88,80,,4.7,percent of total billed charges,80% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% 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,2.94,40,,2.35,percent of total billed charges,40% of total billed charges,2.74,5.88,
ICAR-C TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ICAR-C PLUS TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.95,1.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.56,80,,1.25,percent of total billed charges,80% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% 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,0.78,40,,0.62,percent of total billed charges,40% of total billed charges,0.73,1.56,
ENALAPRIL MALEATE 5M,6400014,CDM,250,RC,,,Outpatient,,,3.45,2.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.76,80,,2.21,percent of total billed charges,80% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% 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,1.38,40,,1.1,percent of total billed charges,40% of total billed charges,1.29,2.76,
ENALAPRIL MALEATE 10,6400014,CDM,250,RC,,,Outpatient,,,5.5,4.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.4,80,,3.52,percent of total billed charges,80% of total billed charges,2.05,37.27,,1.64,percent of total billed charges,37.27% of total billed charges,2.05,37.27,,1.64,percent of total billed charges,37.27% of total billed charges,2.05,37.27,,1.64,percent of total billed charges,37.27% 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,2.2,40,,1.76,percent of total billed charges,40% of total billed charges,2.05,4.4,
OMNICEF 125MG/5ML SU,6400014,CDM,250,RC,,,Outpatient,,,181.35,145.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.08,80,,116.06,percent of total billed charges,80% of total billed charges,67.59,37.27,,54.07,percent of total billed charges,37.27% of total billed charges,67.59,37.27,,54.07,percent of total billed charges,37.27% of total billed charges,67.59,37.27,,54.07,percent of total billed charges,37.27% 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,72.54,40,,58.03,percent of total billed charges,40% of total billed charges,67.59,145.08,
LANTUS INS U-100 (PE,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,126.15,100.92,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.92,80,,80.74,percent of total billed charges,80% of total billed charges,47.02,37.27,,37.62,percent of total billed charges,37.27% of total billed charges,47.02,37.27,,37.62,percent of total billed charges,37.27% of total billed charges,47.02,37.27,,37.62,percent of total billed charges,37.27% 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,50.46,40,,40.37,percent of total billed charges,40% of total billed charges,47.02,100.92,
CALCITRATE CAPLET,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ADVAIR DISKUS 500/50,6400014,CDM,250,RC,,,Outpatient,,,774.5,619.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,619.6,80,,495.68,percent of total billed charges,80% of total billed charges,288.66,37.27,,230.93,percent of total billed charges,37.27% of total billed charges,288.66,37.27,,230.93,percent of total billed charges,37.27% of total billed charges,288.66,37.27,,230.93,percent of total billed charges,37.27% 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,309.8,40,,247.84,percent of total billed charges,40% of total billed charges,288.66,619.6,
SKELAXIN 400MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,4.65,3.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.72,80,,2.98,percent of total billed charges,80% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% 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,1.86,40,,1.49,percent of total billed charges,40% of total billed charges,1.73,3.72,
BACTROBAN 2% CREAM,6400014,CDM,250,RC,,,Outpatient,,,94.21,75.37,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.37,80,,60.3,percent of total billed charges,80% of total billed charges,35.11,37.27,,28.09,percent of total billed charges,37.27% of total billed charges,35.11,37.27,,28.09,percent of total billed charges,37.27% of total billed charges,35.11,37.27,,28.09,percent of total billed charges,37.27% 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,37.68,40,,30.14,percent of total billed charges,40% of total billed charges,35.11,75.37,
BACTROBAN 2% OINTMEN,6400014,CDM,250,RC,,,Outpatient,,,121.61,97.29,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.29,80,,77.83,percent of total billed charges,80% of total billed charges,45.32,37.27,,36.26,percent of total billed charges,37.27% of total billed charges,45.32,37.27,,36.26,percent of total billed charges,37.27% of total billed charges,45.32,37.27,,36.26,percent of total billed charges,37.27% 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,48.64,40,,38.91,percent of total billed charges,40% of total billed charges,45.32,97.29,
GEODON 40MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,22.55,18.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.04,80,,14.43,percent of total billed charges,80% of total billed charges,8.4,37.27,,6.72,percent of total billed charges,37.27% of total billed charges,8.4,37.27,,6.72,percent of total billed charges,37.27% of total billed charges,8.4,37.27,,6.72,percent of total billed charges,37.27% 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,9.02,40,,7.22,percent of total billed charges,40% of total billed charges,8.4,18.04,
ZEMURON INJ 10MG/ML,6400014,CDM,250,RC,,,Outpatient,,,86.65,69.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.32,80,,55.46,percent of total billed charges,80% of total billed charges,32.29,37.27,,25.83,percent of total billed charges,37.27% of total billed charges,32.29,37.27,,25.83,percent of total billed charges,37.27% of total billed charges,32.29,37.27,,25.83,percent of total billed charges,37.27% 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,34.66,40,,27.73,percent of total billed charges,40% of total billed charges,32.29,69.32,
CYTOTEC 100 MCG U/D,6400014,CDM,250,RC,,,Outpatient,,,4.45,3.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.56,80,,2.85,percent of total billed charges,80% of total billed charges,1.66,37.27,,1.33,percent of total billed charges,37.27% of total billed charges,1.66,37.27,,1.33,percent of total billed charges,37.27% of total billed charges,1.66,37.27,,1.33,percent of total billed charges,37.27% 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,1.78,40,,1.42,percent of total billed charges,40% of total billed charges,1.66,3.56,
CETACAINE SPRAY,5880901,CDM,637,RC,,,Outpatient,,,89.15,71.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.32,80,,57.06,percent of total billed charges,80% of total billed charges,33.23,37.27,,26.58,percent of total billed charges,37.27% of total billed charges,33.23,37.27,,26.58,percent of total billed charges,37.27% of total billed charges,33.23,37.27,,26.58,percent of total billed charges,37.27% 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,35.66,40,,28.53,percent of total billed charges,40% of total billed charges,33.23,71.32,
AMINOPHYLLINE 250MG/,6065130,CDM,636,RC,J0280,HCPCS,Outpatient,,,67.6,54.08,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.08,80,,43.26,percent of total billed charges,80% of total billed charges,25.19,37.27,,20.15,percent of total billed charges,37.27% of total billed charges,25.19,37.27,,20.15,percent of total billed charges,37.27% of total billed charges,25.19,37.27,,20.15,percent of total billed charges,37.27% 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,27.04,40,,21.63,percent of total billed charges,40% of total billed charges,25.19,54.08,
VICON FORTE (GENERIC,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
DEXAMETHASONE INJ:5M,6065130,CDM,636,RC,J1100,HCPCS,Outpatient,,,70.6,56.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.48,80,,45.18,percent of total billed charges,80% of total billed charges,26.31,37.27,,21.05,percent of total billed charges,37.27% of total billed charges,26.31,37.27,,21.05,percent of total billed charges,37.27% of total billed charges,26.31,37.27,,21.05,percent of total billed charges,37.27% 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,28.24,40,,22.59,percent of total billed charges,40% of total billed charges,26.31,56.48,
HYDROCORTISONE OINT,6400014,CDM,250,RC,,,Outpatient,,,16.35,13.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.08,80,,10.46,percent of total billed charges,80% of total billed charges,6.09,37.27,,4.87,percent of total billed charges,37.27% of total billed charges,6.09,37.27,,4.87,percent of total billed charges,37.27% of total billed charges,6.09,37.27,,4.87,percent of total billed charges,37.27% 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,6.54,40,,5.23,percent of total billed charges,40% of total billed charges,6.09,13.08,
SYNTHROID 0.15 MG TA,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
HYDROCORTONE 10MG,6400014,CDM,250,RC,,,Outpatient,,,1.95,1.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.56,80,,1.25,percent of total billed charges,80% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% 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,0.78,40,,0.62,percent of total billed charges,40% of total billed charges,0.73,1.56,
ACETAMINOPHEN CAPLET,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PHENOBARB 100MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ASPIRIN SUPP 10GR (6,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
ATROPINE 1MG SINGLE,6065130,CDM,636,RC,J0461,HCPCS,Outpatient,,,40.7,32.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.56,80,,26.05,percent of total billed charges,80% of total billed charges,15.17,37.27,,12.14,percent of total billed charges,37.27% of total billed charges,15.17,37.27,,12.14,percent of total billed charges,37.27% of total billed charges,15.17,37.27,,12.14,percent of total billed charges,37.27% 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,16.28,40,,13.02,percent of total billed charges,40% of total billed charges,15.17,32.56,
NUTRADERM LOTION 16,6400014,CDM,250,RC,,,Outpatient,,,29.4,23.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.52,80,,18.82,percent of total billed charges,80% of total billed charges,10.96,37.27,,8.77,percent of total billed charges,37.27% of total billed charges,10.96,37.27,,8.77,percent of total billed charges,37.27% of total billed charges,10.96,37.27,,8.77,percent of total billed charges,37.27% 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,11.76,40,,9.41,percent of total billed charges,40% of total billed charges,10.96,23.52,
NEBCIN (TOBRAMYCIN),6065130,CDM,636,RC,J3260,HCPCS,Outpatient,,,89.1,71.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.28,80,,57.02,percent of total billed charges,80% of total billed charges,33.21,37.27,,26.57,percent of total billed charges,37.27% of total billed charges,33.21,37.27,,26.57,percent of total billed charges,37.27% of total billed charges,33.21,37.27,,26.57,percent of total billed charges,37.27% 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,35.64,40,,28.51,percent of total billed charges,40% of total billed charges,33.21,71.28,
GI COCKTAIL 30ML,6400014,CDM,250,RC,,,Outpatient,,,30,24.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% 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,12,40,,9.6,percent of total billed charges,40% of total billed charges,11.18,24,
PYRAZINAMIDE 500MG T,6400014,CDM,250,RC,,,Outpatient,,,17.4,13.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.92,80,,11.14,percent of total billed charges,80% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% 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,6.96,40,,5.57,percent of total billed charges,40% of total billed charges,6.48,13.92,
NEUROTIN CAP 100MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
NITROLINGUAL SPRAY,6400014,CDM,250,RC,,,Outpatient,,,585.85,468.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,468.68,80,,374.94,percent of total billed charges,80% of total billed charges,218.35,37.27,,174.68,percent of total billed charges,37.27% of total billed charges,218.35,37.27,,174.68,percent of total billed charges,37.27% of total billed charges,218.35,37.27,,174.68,percent of total billed charges,37.27% 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,234.34,40,,187.47,percent of total billed charges,40% of total billed charges,218.35,468.68,
TYLENOL 500MG CAP,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
HEMABATE 250MCG,6400014,CDM,250,RC,,,Outpatient,,,1286.6,1029.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1029.28,80,,823.42,percent of total billed charges,80% of total billed charges,479.52,37.27,,383.62,percent of total billed charges,37.27% of total billed charges,479.52,37.27,,383.62,percent of total billed charges,37.27% of total billed charges,479.52,37.27,,383.62,percent of total billed charges,37.27% 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,514.64,40,,411.71,percent of total billed charges,40% of total billed charges,479.52,1029.28,
DELTASONE 2.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
COLYTE 4-LITER,6400014,CDM,250,RC,,,Outpatient,,,57.25,45.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.8,80,,36.64,percent of total billed charges,80% of total billed charges,21.34,37.27,,17.07,percent of total billed charges,37.27% of total billed charges,21.34,37.27,,17.07,percent of total billed charges,37.27% of total billed charges,21.34,37.27,,17.07,percent of total billed charges,37.27% 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,22.9,40,,18.32,percent of total billed charges,40% of total billed charges,21.34,45.8,
CAPOZIDE 25/15 TAB,6400014,CDM,250,RC,,,Outpatient,,,2.5,2.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
MORPHINE 10MG CARPUJ,6065130,CDM,636,RC,J2270,HCPCS,Outpatient,,,13.1,10.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.48,80,,8.38,percent of total billed charges,80% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% 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,5.24,40,,4.19,percent of total billed charges,40% of total billed charges,4.88,10.48,
TRANSDERM SCOP,6400014,CDM,250,RC,,,Outpatient,,,79.45,63.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.56,80,,50.85,percent of total billed charges,80% of total billed charges,29.61,37.27,,23.69,percent of total billed charges,37.27% of total billed charges,29.61,37.27,,23.69,percent of total billed charges,37.27% of total billed charges,29.61,37.27,,23.69,percent of total billed charges,37.27% 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,31.78,40,,25.42,percent of total billed charges,40% of total billed charges,29.61,63.56,
SANDOSTATIN 2MG MDV,6065130,CDM,636,RC,J2354,HCPCS,Outpatient,,,163.8,131.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.04,80,,104.83,percent of total billed charges,80% of total billed charges,61.05,37.27,,48.84,percent of total billed charges,37.27% of total billed charges,61.05,37.27,,48.84,percent of total billed charges,37.27% of total billed charges,61.05,37.27,,48.84,percent of total billed charges,37.27% 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,65.52,40,,52.42,percent of total billed charges,40% of total billed charges,61.05,131.04,
SODIUM CHLORIDE 0.9%,6400014,CDM,250,RC,,,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
PRELONE SYRUP 15MG/5,6400014,CDM,250,RC,,,Outpatient,,,64.05,51.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.24,80,,40.99,percent of total billed charges,80% of total billed charges,23.87,37.27,,19.1,percent of total billed charges,37.27% of total billed charges,23.87,37.27,,19.1,percent of total billed charges,37.27% of total billed charges,23.87,37.27,,19.1,percent of total billed charges,37.27% 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,25.62,40,,20.5,percent of total billed charges,40% of total billed charges,23.87,51.24,
FUROSEMIDE 80MG UD T,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
PROMETHAZINE 50MG TA,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
PHENAZOPYRIDINE 200M,6400014,CDM,250,RC,,,Outpatient,,,8.2,6.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.56,80,,5.25,percent of total billed charges,80% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% 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,3.28,40,,2.62,percent of total billed charges,40% of total billed charges,3.06,6.56,
THIAMINE INJ 100MG/C,6065130,CDM,636,RC,J3411,HCPCS,Outpatient,,,42.4,33.92,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.92,80,,27.14,percent of total billed charges,80% of total billed charges,15.8,37.27,,12.64,percent of total billed charges,37.27% of total billed charges,15.8,37.27,,12.64,percent of total billed charges,37.27% of total billed charges,15.8,37.27,,12.64,percent of total billed charges,37.27% 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,16.96,40,,13.57,percent of total billed charges,40% of total billed charges,15.8,33.92,
"PENICILLIN GK 5,000,",6065130,CDM,636,RC,J2540,HCPCS,Outpatient,,,143.8,115.04,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.04,80,,92.03,percent of total billed charges,80% of total billed charges,53.59,37.27,,42.87,percent of total billed charges,37.27% of total billed charges,53.59,37.27,,42.87,percent of total billed charges,37.27% of total billed charges,53.59,37.27,,42.87,percent of total billed charges,37.27% 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,57.52,40,,46.02,percent of total billed charges,40% of total billed charges,53.59,115.04,
HALCION 0.125MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.15,1.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.72,80,,1.38,percent of total billed charges,80% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% 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,0.86,40,,0.69,percent of total billed charges,40% of total billed charges,0.8,1.72,
ANTIHEMOPHILIC FACTO,6400014,CDM,250,RC,,,Outpatient,,,1.39,1.11,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.11,80,,0.89,percent of total billed charges,80% of total billed charges,0.52,37.27,,0.42,percent of total billed charges,37.27% of total billed charges,0.52,37.27,,0.42,percent of total billed charges,37.27% of total billed charges,0.52,37.27,,0.42,percent of total billed charges,37.27% 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,0.56,40,,0.45,percent of total billed charges,40% of total billed charges,0.52,1.11,
AMOXIL SUSP 250MG/5M,6400014,CDM,250,RC,,,Outpatient,,,23.5,18.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.8,80,,15.04,percent of total billed charges,80% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% 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,9.4,40,,7.52,percent of total billed charges,40% of total billed charges,8.76,18.8,
HUMULIN L INSULIN,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,11.75,9.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.4,80,,7.52,percent of total billed charges,80% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% 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,4.7,40,,3.76,percent of total billed charges,40% of total billed charges,4.38,9.4,
LORTAB 7.5MG,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
ROCEPHIN:250MG IM/IV,6065130,CDM,636,RC,J0696,HCPCS,Outpatient,,,54.4,43.52,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,80,,34.82,percent of total billed charges,80% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% 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,21.76,40,,17.41,percent of total billed charges,40% of total billed charges,20.27,43.52,
HEPARIN PEDIATRIC FL,6065130,CDM,636,RC,J1642,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
GOLYTELY,5880901,CDM,637,RC,,,Outpatient,,,83.75,67.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67,80,,53.6,percent of total billed charges,80% of total billed charges,31.21,37.27,,24.97,percent of total billed charges,37.27% of total billed charges,31.21,37.27,,24.97,percent of total billed charges,37.27% of total billed charges,31.21,37.27,,24.97,percent of total billed charges,37.27% 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,33.5,40,,26.8,percent of total billed charges,40% of total billed charges,31.21,67,
MYDFRIN 2.5% 3CC,6400014,CDM,250,RC,,,Outpatient,,,84.55,67.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.64,80,,54.11,percent of total billed charges,80% of total billed charges,31.51,37.27,,25.21,percent of total billed charges,37.27% of total billed charges,31.51,37.27,,25.21,percent of total billed charges,37.27% of total billed charges,31.51,37.27,,25.21,percent of total billed charges,37.27% 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,33.82,40,,27.06,percent of total billed charges,40% of total billed charges,31.51,67.64,
TAMBOCOR 100MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,14.05,11.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.24,80,,8.99,percent of total billed charges,80% of total billed charges,5.24,37.27,,4.19,percent of total billed charges,37.27% of total billed charges,5.24,37.27,,4.19,percent of total billed charges,37.27% of total billed charges,5.24,37.27,,4.19,percent of total billed charges,37.27% 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,5.62,40,,4.5,percent of total billed charges,40% of total billed charges,5.24,11.24,
SODIUM CHLORIDE 1GM,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ALDACTONE 50MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,5.25,4.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.2,80,,3.36,percent of total billed charges,80% of total billed charges,1.96,37.27,,1.57,percent of total billed charges,37.27% of total billed charges,1.96,37.27,,1.57,percent of total billed charges,37.27% of total billed charges,1.96,37.27,,1.57,percent of total billed charges,37.27% 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,2.1,40,,1.68,percent of total billed charges,40% of total billed charges,1.96,4.2,
NORMODYNE 5MG/CC 1CC,6400014,CDM,250,RC,,,Outpatient,,,29.16,23.33,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.33,80,,18.66,percent of total billed charges,80% of total billed charges,10.87,37.27,,8.7,percent of total billed charges,37.27% of total billed charges,10.87,37.27,,8.7,percent of total billed charges,37.27% of total billed charges,10.87,37.27,,8.7,percent of total billed charges,37.27% 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,11.66,40,,9.33,percent of total billed charges,40% of total billed charges,10.87,23.33,
NOVOLIN N INSULIN,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,64.2,51.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.36,80,,41.09,percent of total billed charges,80% of total billed charges,23.93,37.27,,19.14,percent of total billed charges,37.27% of total billed charges,23.93,37.27,,19.14,percent of total billed charges,37.27% of total billed charges,23.93,37.27,,19.14,percent of total billed charges,37.27% 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,25.68,40,,20.54,percent of total billed charges,40% of total billed charges,23.93,51.36,
BUSPAR 5MG U/D,6400014,CDM,250,RC,,,Outpatient,,,2.65,2.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.12,80,,1.7,percent of total billed charges,80% of total billed charges,0.99,37.27,,0.79,percent of total billed charges,37.27% of total billed charges,0.99,37.27,,0.79,percent of total billed charges,37.27% of total billed charges,0.99,37.27,,0.79,percent of total billed charges,37.27% 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,1.06,40,,0.85,percent of total billed charges,40% of total billed charges,0.99,2.12,
PEPCID IV 20MG/2ML,6065130,CDM,636,RC,S0028,HCPCS,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
PEPCID 20MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,5.9,4.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.72,80,,3.78,percent of total billed charges,80% of total billed charges,2.2,37.27,,1.76,percent of total billed charges,37.27% of total billed charges,2.2,37.27,,1.76,percent of total billed charges,37.27% of total billed charges,2.2,37.27,,1.76,percent of total billed charges,37.27% 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,2.36,40,,1.89,percent of total billed charges,40% of total billed charges,2.2,4.72,
MAALOX 1OZ UD,6400014,CDM,250,RC,,,Outpatient,,,19.3,15.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.44,80,,12.35,percent of total billed charges,80% of total billed charges,7.19,37.27,,5.75,percent of total billed charges,37.27% of total billed charges,7.19,37.27,,5.75,percent of total billed charges,37.27% of total billed charges,7.19,37.27,,5.75,percent of total billed charges,37.27% 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,7.72,40,,6.18,percent of total billed charges,40% of total billed charges,7.19,15.44,
ACLOVATE CREAM 0.05%,6400014,CDM,250,RC,,,Outpatient,,,152.6,122.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.08,80,,97.66,percent of total billed charges,80% of total billed charges,56.87,37.27,,45.5,percent of total billed charges,37.27% of total billed charges,56.87,37.27,,45.5,percent of total billed charges,37.27% of total billed charges,56.87,37.27,,45.5,percent of total billed charges,37.27% 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,61.04,40,,48.83,percent of total billed charges,40% of total billed charges,56.87,122.08,
BUSPAR 10MG U/D,6400014,CDM,250,RC,,,Outpatient,,,4.65,3.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.72,80,,2.98,percent of total billed charges,80% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% 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,1.86,40,,1.49,percent of total billed charges,40% of total billed charges,1.73,3.72,
ISOPTIN SR 240 TAB U,6400014,CDM,250,RC,,,Outpatient,,,4.7,3.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.76,80,,3.01,percent of total billed charges,80% of total billed charges,1.75,37.27,,1.4,percent of total billed charges,37.27% of total billed charges,1.75,37.27,,1.4,percent of total billed charges,37.27% of total billed charges,1.75,37.27,,1.4,percent of total billed charges,37.27% 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,1.88,40,,1.5,percent of total billed charges,40% of total billed charges,1.75,3.76,
DIURIL 0.5GM INJ,6065130,CDM,636,RC,J1205,HCPCS,Outpatient,,,1873.65,1498.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1498.92,80,,1199.14,percent of total billed charges,80% of total billed charges,698.31,37.27,,558.65,percent of total billed charges,37.27% of total billed charges,698.31,37.27,,558.65,percent of total billed charges,37.27% of total billed charges,698.31,37.27,,558.65,percent of total billed charges,37.27% 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,749.46,40,,599.57,percent of total billed charges,40% of total billed charges,698.31,1498.92,
ANALPRAM HC,6400014,CDM,250,RC,,,Outpatient,,,457.45,365.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,365.96,80,,292.77,percent of total billed charges,80% of total billed charges,170.49,37.27,,136.39,percent of total billed charges,37.27% of total billed charges,170.49,37.27,,136.39,percent of total billed charges,37.27% of total billed charges,170.49,37.27,,136.39,percent of total billed charges,37.27% 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,182.98,40,,146.38,percent of total billed charges,40% of total billed charges,170.49,365.96,
ISORDIL 40MG PLAIN,6400014,CDM,250,RC,,,Outpatient,,,1.8,1.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.44,80,,1.15,percent of total billed charges,80% of total billed charges,0.67,37.27,,0.54,percent of total billed charges,37.27% of total billed charges,0.67,37.27,,0.54,percent of total billed charges,37.27% of total billed charges,0.67,37.27,,0.54,percent of total billed charges,37.27% 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,0.72,40,,0.58,percent of total billed charges,40% of total billed charges,0.67,1.44,
NIZORAL CREAM 15GM,6400014,CDM,250,RC,,,Outpatient,,,47.97,38.38,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.38,80,,30.7,percent of total billed charges,80% of total billed charges,17.88,37.27,,14.3,percent of total billed charges,37.27% of total billed charges,17.88,37.27,,14.3,percent of total billed charges,37.27% of total billed charges,17.88,37.27,,14.3,percent of total billed charges,37.27% 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,19.19,40,,15.35,percent of total billed charges,40% of total billed charges,17.88,38.38,
ATROVENT INHALER,6400014,CDM,250,RC,,,Outpatient,,,197.15,157.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.72,80,,126.18,percent of total billed charges,80% of total billed charges,73.48,37.27,,58.78,percent of total billed charges,37.27% of total billed charges,73.48,37.27,,58.78,percent of total billed charges,37.27% of total billed charges,73.48,37.27,,58.78,percent of total billed charges,37.27% 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,78.86,40,,63.09,percent of total billed charges,40% of total billed charges,73.48,157.72,
FIBERCON UD,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
MS CONTIN 30MG U/D,6400014,CDM,250,RC,,,Outpatient,,,19.8,15.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.84,80,,12.67,percent of total billed charges,80% of total billed charges,7.38,37.27,,5.9,percent of total billed charges,37.27% of total billed charges,7.38,37.27,,5.9,percent of total billed charges,37.27% of total billed charges,7.38,37.27,,5.9,percent of total billed charges,37.27% 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,7.92,40,,6.34,percent of total billed charges,40% of total billed charges,7.38,15.84,
DURAMORPH-PF 10MG./1,6400014,CDM,250,RC,,,Outpatient,,,39.6,31.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.68,80,,25.34,percent of total billed charges,80% of total billed charges,14.76,37.27,,11.81,percent of total billed charges,37.27% of total billed charges,14.76,37.27,,11.81,percent of total billed charges,37.27% of total billed charges,14.76,37.27,,11.81,percent of total billed charges,37.27% 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,15.84,40,,12.67,percent of total billed charges,40% of total billed charges,14.76,31.68,
FOSAMAX 70MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,171.3,137.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.04,80,,109.63,percent of total billed charges,80% of total billed charges,63.84,37.27,,51.07,percent of total billed charges,37.27% of total billed charges,63.84,37.27,,51.07,percent of total billed charges,37.27% of total billed charges,63.84,37.27,,51.07,percent of total billed charges,37.27% 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,68.52,40,,54.82,percent of total billed charges,40% of total billed charges,63.84,137.04,
PATANOL 0.1% EYE DRO,6400014,CDM,250,RC,,,Outpatient,,,1014.8,811.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,811.84,80,,649.47,percent of total billed charges,80% of total billed charges,378.22,37.27,,302.58,percent of total billed charges,37.27% of total billed charges,378.22,37.27,,302.58,percent of total billed charges,37.27% of total billed charges,378.22,37.27,,302.58,percent of total billed charges,37.27% 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,405.92,40,,324.74,percent of total billed charges,40% of total billed charges,378.22,811.84,
ALLEGRA-D TABLET,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
PERATIVE LIQUID,6400014,CDM,250,RC,,,Outpatient,,,13.3,10.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.64,80,,8.51,percent of total billed charges,80% of total billed charges,4.96,37.27,,3.97,percent of total billed charges,37.27% of total billed charges,4.96,37.27,,3.97,percent of total billed charges,37.27% of total billed charges,4.96,37.27,,3.97,percent of total billed charges,37.27% 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,5.32,40,,4.26,percent of total billed charges,40% of total billed charges,4.96,10.64,
UNIRETIC 7.5/12.5MG,6400014,CDM,250,RC,,,Outpatient,,,10.25,8.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.2,80,,6.56,percent of total billed charges,80% of total billed charges,3.82,37.27,,3.06,percent of total billed charges,37.27% of total billed charges,3.82,37.27,,3.06,percent of total billed charges,37.27% of total billed charges,3.82,37.27,,3.06,percent of total billed charges,37.27% 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,4.1,40,,3.28,percent of total billed charges,40% of total billed charges,3.82,8.2,
KETOROLAC 10MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,7.35,5.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.88,80,,4.7,percent of total billed charges,80% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% 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,2.94,40,,2.35,percent of total billed charges,40% of total billed charges,2.74,5.88,
DETROL LA 4MG CAPSUL,6400014,CDM,250,RC,,,Outpatient,,,56.2,44.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.96,80,,35.97,percent of total billed charges,80% of total billed charges,20.95,37.27,,16.76,percent of total billed charges,37.27% of total billed charges,20.95,37.27,,16.76,percent of total billed charges,37.27% of total billed charges,20.95,37.27,,16.76,percent of total billed charges,37.27% 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,22.48,40,,17.98,percent of total billed charges,40% of total billed charges,20.95,44.96,
PROTONIX IV 40MG VIA,6065130,CDM,636,RC,J2470,HCPCS,Outpatient,,,99,79.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% 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,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,36.9,79.2,
GENTAMICIN 40MG/ML (,6065130,CDM,636,RC,J1580,HCPCS,Outpatient,,,136.3,109.04,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.04,80,,87.23,percent of total billed charges,80% of total billed charges,50.8,37.27,,40.64,percent of total billed charges,37.27% of total billed charges,50.8,37.27,,40.64,percent of total billed charges,37.27% of total billed charges,50.8,37.27,,40.64,percent of total billed charges,37.27% 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,54.52,40,,43.62,percent of total billed charges,40% of total billed charges,50.8,109.04,
PEDIATEX-D LIQUID,6400014,CDM,250,RC,,,Outpatient,,,10.85,8.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.68,80,,6.94,percent of total billed charges,80% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% 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,4.34,40,,3.47,percent of total billed charges,40% of total billed charges,4.04,8.68,
PEDIATEX 2MG/5ML LIQ,6400014,CDM,250,RC,,,Outpatient,,,10.75,8.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.6,80,,6.88,percent of total billed charges,80% of total billed charges,4.01,37.27,,3.21,percent of total billed charges,37.27% of total billed charges,4.01,37.27,,3.21,percent of total billed charges,37.27% of total billed charges,4.01,37.27,,3.21,percent of total billed charges,37.27% 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,4.3,40,,3.44,percent of total billed charges,40% of total billed charges,4.01,8.6,
UNASYN 1.5GM,6065130,CDM,636,RC,J0295,HCPCS,Outpatient,,,44.8,35.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.84,80,,28.67,percent of total billed charges,80% of total billed charges,16.7,37.27,,13.36,percent of total billed charges,37.27% of total billed charges,16.7,37.27,,13.36,percent of total billed charges,37.27% of total billed charges,16.7,37.27,,13.36,percent of total billed charges,37.27% 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,17.92,40,,14.34,percent of total billed charges,40% of total billed charges,16.7,35.84,
UNASYN 3GM IM/IV,6065130,CDM,636,RC,J0295,HCPCS,Outpatient,,,89.6,71.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.68,80,,57.34,percent of total billed charges,80% of total billed charges,33.39,37.27,,26.71,percent of total billed charges,37.27% of total billed charges,33.39,37.27,,26.71,percent of total billed charges,37.27% of total billed charges,33.39,37.27,,26.71,percent of total billed charges,37.27% 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,35.84,40,,28.67,percent of total billed charges,40% of total billed charges,33.39,71.68,
CHLORZOXAZONE 500MG,6400014,CDM,250,RC,,,Outpatient,,,2.85,2.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,80,,1.82,percent of total billed charges,80% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% 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,1.14,40,,0.91,percent of total billed charges,40% of total billed charges,1.06,2.28,
AZMACORT INHALER,6400014,CDM,250,RC,,,Outpatient,,,427.95,342.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,342.36,80,,273.89,percent of total billed charges,80% of total billed charges,159.5,37.27,,127.6,percent of total billed charges,37.27% of total billed charges,159.5,37.27,,127.6,percent of total billed charges,37.27% of total billed charges,159.5,37.27,,127.6,percent of total billed charges,37.27% 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,171.18,40,,136.94,percent of total billed charges,40% of total billed charges,159.5,342.36,
CLINDAMYCIN 900MG IN,6065130,CDM,636,RC,J3490,HCPCS,Outpatient,,,89.15,71.32,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.32,80,,57.06,percent of total billed charges,80% of total billed charges,33.23,37.27,,26.58,percent of total billed charges,37.27% of total billed charges,33.23,37.27,,26.58,percent of total billed charges,37.27% of total billed charges,33.23,37.27,,26.58,percent of total billed charges,37.27% 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,35.66,40,,28.53,percent of total billed charges,40% of total billed charges,33.23,71.32,
INAPSINE 1CC,6065130,CDM,636,RC,J1790,HCPCS,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
BICITRA 15CC,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
SYNTHROID 0.05 MG TA,6400014,CDM,250,RC,,,Outpatient,,,6.45,5.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.16,80,,4.13,percent of total billed charges,80% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% 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,2.58,40,,2.06,percent of total billed charges,40% of total billed charges,2.4,5.16,
HEPARIN 10ML FLUSH,6400014,CDM,250,RC,,,Outpatient,,,22.9,18.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.32,80,,14.66,percent of total billed charges,80% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% 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,9.16,40,,7.33,percent of total billed charges,40% of total billed charges,8.53,18.32,
CORDARONE TAB 200MG,6400014,CDM,250,RC,,,Outpatient,,,8.85,7.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.08,80,,5.66,percent of total billed charges,80% of total billed charges,3.3,37.27,,2.64,percent of total billed charges,37.27% of total billed charges,3.3,37.27,,2.64,percent of total billed charges,37.27% of total billed charges,3.3,37.27,,2.64,percent of total billed charges,37.27% 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,3.54,40,,2.83,percent of total billed charges,40% of total billed charges,3.3,7.08,
CIPRO 250MG TAB,6400014,CDM,250,RC,,,Outpatient,,,9.25,7.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.4,80,,5.92,percent of total billed charges,80% of total billed charges,3.45,37.27,,2.76,percent of total billed charges,37.27% of total billed charges,3.45,37.27,,2.76,percent of total billed charges,37.27% of total billed charges,3.45,37.27,,2.76,percent of total billed charges,37.27% 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,3.7,40,,2.96,percent of total billed charges,40% of total billed charges,3.45,7.4,
ELOCON CREAM 0.1% 15,6400014,CDM,250,RC,,,Outpatient,,,45.2,36.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.16,80,,28.93,percent of total billed charges,80% of total billed charges,16.85,37.27,,13.48,percent of total billed charges,37.27% of total billed charges,16.85,37.27,,13.48,percent of total billed charges,37.27% of total billed charges,16.85,37.27,,13.48,percent of total billed charges,37.27% 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,18.08,40,,14.46,percent of total billed charges,40% of total billed charges,16.85,36.16,
ZESTRIL 10MG TAB (PR,6400014,CDM,250,RC,,,Outpatient,,,3.1,2.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.48,80,,1.98,percent of total billed charges,80% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% 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,1.24,40,,0.99,percent of total billed charges,40% of total billed charges,1.16,2.48,
BETADINE OINT 1/32,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
CIPRO 750MG,6400014,CDM,250,RC,,,Outpatient,,,18.6,14.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.88,80,,11.9,percent of total billed charges,80% of total billed charges,6.93,37.27,,5.54,percent of total billed charges,37.27% of total billed charges,6.93,37.27,,5.54,percent of total billed charges,37.27% of total billed charges,6.93,37.27,,5.54,percent of total billed charges,37.27% 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,7.44,40,,5.95,percent of total billed charges,40% of total billed charges,6.93,14.88,
OSMOLITE 8OZ,6400014,CDM,250,RC,,,Outpatient,,,7.2,5.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,80,,4.61,percent of total billed charges,80% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% 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,2.88,40,,2.3,percent of total billed charges,40% of total billed charges,2.68,5.76,
VOLMAX 4MG,6400014,CDM,250,RC,,,Outpatient,,,7.9,6.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.32,80,,5.06,percent of total billed charges,80% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% 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,3.16,40,,2.53,percent of total billed charges,40% of total billed charges,2.94,6.32,
PRINIVIL 10MG,6400014,CDM,250,RC,,,Outpatient,,,2.9,2.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.32,80,,1.86,percent of total billed charges,80% of total billed charges,1.08,37.27,,0.86,percent of total billed charges,37.27% of total billed charges,1.08,37.27,,0.86,percent of total billed charges,37.27% of total billed charges,1.08,37.27,,0.86,percent of total billed charges,37.27% 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,1.16,40,,0.93,percent of total billed charges,40% of total billed charges,1.08,2.32,
DEMADEX INJ 20MG/2ML,6065130,CDM,636,RC,J3265,HCPCS,Outpatient,,,31.15,24.92,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.92,80,,19.94,percent of total billed charges,80% of total billed charges,11.61,37.27,,9.29,percent of total billed charges,37.27% of total billed charges,11.61,37.27,,9.29,percent of total billed charges,37.27% of total billed charges,11.61,37.27,,9.29,percent of total billed charges,37.27% 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,12.46,40,,9.97,percent of total billed charges,40% of total billed charges,11.61,24.92,
LEUCOVORIN CALCIUM 5,6065130,CDM,636,RC,J0640,HCPCS,Outpatient,,,67.49,53.99,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.99,80,,43.19,percent of total billed charges,80% of total billed charges,25.15,37.27,,20.12,percent of total billed charges,37.27% of total billed charges,25.15,37.27,,20.12,percent of total billed charges,37.27% of total billed charges,25.15,37.27,,20.12,percent of total billed charges,37.27% 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,27,40,,21.6,percent of total billed charges,40% of total billed charges,25.15,53.99,
MEXITIL 150MG CAP,6400014,CDM,250,RC,,,Outpatient,,,2.5,2.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
ESTRACE 2MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PCA MEPERIDINE 10ML/,6400014,CDM,250,RC,,,Outpatient,,,94.1,75.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.28,80,,60.22,percent of total billed charges,80% of total billed charges,35.07,37.27,,28.06,percent of total billed charges,37.27% of total billed charges,35.07,37.27,,28.06,percent of total billed charges,37.27% of total billed charges,35.07,37.27,,28.06,percent of total billed charges,37.27% 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,37.64,40,,30.11,percent of total billed charges,40% of total billed charges,35.07,75.28,
LORCET PLUS UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
K-DUR 20MEQ U/D,6400014,CDM,250,RC,,,Outpatient,,,2.3,1.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.84,80,,1.47,percent of total billed charges,80% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% 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,0.92,40,,0.74,percent of total billed charges,40% of total billed charges,0.86,1.84,
ERYTHROMYCIN OPHTH,6400014,CDM,250,RC,,,Outpatient,,,34.8,27.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.84,80,,22.27,percent of total billed charges,80% of total billed charges,12.97,37.27,,10.38,percent of total billed charges,37.27% of total billed charges,12.97,37.27,,10.38,percent of total billed charges,37.27% of total billed charges,12.97,37.27,,10.38,percent of total billed charges,37.27% 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,13.92,40,,11.14,percent of total billed charges,40% of total billed charges,12.97,27.84,
EVAC-Q-KIT,6400014,CDM,250,RC,,,Outpatient,,,27.9,22.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.32,80,,17.86,percent of total billed charges,80% of total billed charges,10.4,37.27,,8.32,percent of total billed charges,37.27% of total billed charges,10.4,37.27,,8.32,percent of total billed charges,37.27% of total billed charges,10.4,37.27,,8.32,percent of total billed charges,37.27% 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,11.16,40,,8.93,percent of total billed charges,40% of total billed charges,10.4,22.32,
ESTRACE 1MG,6400014,CDM,250,RC,,,Outpatient,,,16.5,13.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,80,,10.56,percent of total billed charges,80% of total billed charges,6.15,37.27,,4.92,percent of total billed charges,37.27% of total billed charges,6.15,37.27,,4.92,percent of total billed charges,37.27% of total billed charges,6.15,37.27,,4.92,percent of total billed charges,37.27% 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,6.6,40,,5.28,percent of total billed charges,40% of total billed charges,6.15,13.2,
TRIPLE DYE APPLICATO,6400014,CDM,250,RC,,,Outpatient,,,3.85,3.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.08,80,,2.46,percent of total billed charges,80% of total billed charges,1.43,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.43,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.43,37.27,,1.14,percent of total billed charges,37.27% 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,1.54,40,,1.23,percent of total billed charges,40% of total billed charges,1.43,3.08,
PROCALAMINE SOLUTION,6400014,CDM,250,RC,,,Outpatient,,,203.1,162.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.48,80,,129.98,percent of total billed charges,80% of total billed charges,75.7,37.27,,60.56,percent of total billed charges,37.27% of total billed charges,75.7,37.27,,60.56,percent of total billed charges,37.27% of total billed charges,75.7,37.27,,60.56,percent of total billed charges,37.27% 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,81.24,40,,64.99,percent of total billed charges,40% of total billed charges,75.7,162.48,
ENLON 15ML,6400014,CDM,250,RC,,,Outpatient,,,51,40.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,19.01,37.27,,15.21,percent of total billed charges,37.27% of total billed charges,19.01,37.27,,15.21,percent of total billed charges,37.27% of total billed charges,19.01,37.27,,15.21,percent of total billed charges,37.27% 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,20.4,40,,16.32,percent of total billed charges,40% of total billed charges,19.01,40.8,
PROZAC CAPSULE 20MG,6400014,CDM,250,RC,,,Outpatient,,,6.05,4.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,80,,3.87,percent of total billed charges,80% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% 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,2.42,40,,1.94,percent of total billed charges,40% of total billed charges,2.25,4.84,
ADVIL TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ANAPROX DS 550MG TAB,6400014,CDM,250,RC,,,Outpatient,,,4.2,3.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.36,80,,2.69,percent of total billed charges,80% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% 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,1.68,40,,1.34,percent of total billed charges,40% of total billed charges,1.57,3.36,
SOD.CHLORIDE CONC.,6400014,CDM,250,RC,,,Outpatient,,,18.35,14.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.68,80,,11.74,percent of total billed charges,80% of total billed charges,6.84,37.27,,5.47,percent of total billed charges,37.27% of total billed charges,6.84,37.27,,5.47,percent of total billed charges,37.27% of total billed charges,6.84,37.27,,5.47,percent of total billed charges,37.27% 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,7.34,40,,5.87,percent of total billed charges,40% of total billed charges,6.84,14.68,
STERILE WATER INJ 50,5645742,CDM,270,RC,,,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
VANCOCIN 125MG CAP U,6400014,CDM,250,RC,,,Outpatient,,,136.15,108.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.92,80,,87.14,percent of total billed charges,80% of total billed charges,50.74,37.27,,40.59,percent of total billed charges,37.27% of total billed charges,50.74,37.27,,40.59,percent of total billed charges,37.27% of total billed charges,50.74,37.27,,40.59,percent of total billed charges,37.27% 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,54.46,40,,43.57,percent of total billed charges,40% of total billed charges,50.74,108.92,
HESPAN : 500ML,6400014,CDM,250,RC,,,Outpatient,,,248.95,199.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.16,80,,159.33,percent of total billed charges,80% of total billed charges,92.78,37.27,,74.22,percent of total billed charges,37.27% of total billed charges,92.78,37.27,,74.22,percent of total billed charges,37.27% of total billed charges,92.78,37.27,,74.22,percent of total billed charges,37.27% 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,99.58,40,,79.66,percent of total billed charges,40% of total billed charges,92.78,199.16,
MAXZIDE-25 TAB UD,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
PHAZYME 125 CAP,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
HEPATITIS B INJ,6065130,CDM,636,RC,J1571,HCPCS,Outpatient,,,211.96,169.57,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,169.57,80,,135.66,percent of total billed charges,80% of total billed charges,79,37.27,,63.2,percent of total billed charges,37.27% of total billed charges,79,37.27,,63.2,percent of total billed charges,37.27% of total billed charges,79,37.27,,63.2,percent of total billed charges,37.27% of total billed charges,68.66,100,,,fee schedule,100% of APC rate,68.66,100,,,fee schedule,100% of APC rate,68.66,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,68.66,100,,,fee schedule,100% of APC rate,68.66,100,,,fee schedule,100% of APC rate,68.66,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.78,40,,67.82,percent of total billed charges,40% of total billed charges,68.66,169.57,
XYLOCAINE 0.5% 50CC,6400014,CDM,250,RC,,,Outpatient,,,15.25,12.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.2,80,,9.76,percent of total billed charges,80% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% 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,6.1,40,,4.88,percent of total billed charges,40% of total billed charges,5.68,12.2,
E.E.S. DROPS,6400014,CDM,250,RC,,,Outpatient,,,20.8,16.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.64,80,,13.31,percent of total billed charges,80% of total billed charges,7.75,37.27,,6.2,percent of total billed charges,37.27% of total billed charges,7.75,37.27,,6.2,percent of total billed charges,37.27% of total billed charges,7.75,37.27,,6.2,percent of total billed charges,37.27% 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,8.32,40,,6.66,percent of total billed charges,40% of total billed charges,7.75,16.64,
BEN-GAY 1.25OZ,6400014,CDM,250,RC,,,Outpatient,,,14.9,11.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.92,80,,9.54,percent of total billed charges,80% of total billed charges,5.55,37.27,,4.44,percent of total billed charges,37.27% of total billed charges,5.55,37.27,,4.44,percent of total billed charges,37.27% of total billed charges,5.55,37.27,,4.44,percent of total billed charges,37.27% 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,5.96,40,,4.77,percent of total billed charges,40% of total billed charges,5.55,11.92,
NEO-SYNEPHRINE NOSE,6400014,CDM,250,RC,,,Outpatient,,,13.4,10.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.72,80,,8.58,percent of total billed charges,80% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% 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,5.36,40,,4.29,percent of total billed charges,40% of total billed charges,4.99,10.72,
TIAZAC 360MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,5.8,4.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.64,80,,3.71,percent of total billed charges,80% of total billed charges,2.16,37.27,,1.73,percent of total billed charges,37.27% of total billed charges,2.16,37.27,,1.73,percent of total billed charges,37.27% of total billed charges,2.16,37.27,,1.73,percent of total billed charges,37.27% 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,2.32,40,,1.86,percent of total billed charges,40% of total billed charges,2.16,4.64,
AVANDIA 4MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,15.95,12.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.76,80,,10.21,percent of total billed charges,80% of total billed charges,5.94,37.27,,4.75,percent of total billed charges,37.27% of total billed charges,5.94,37.27,,4.75,percent of total billed charges,37.27% of total billed charges,5.94,37.27,,4.75,percent of total billed charges,37.27% 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,6.38,40,,5.1,percent of total billed charges,40% of total billed charges,5.94,12.76,
XYLOCAINE 1% INJ 2ML,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
MARCAINE 0.75% VIAL,6400014,CDM,250,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
BETADINE SWABSTICKS,5880901,CDM,637,RC,,,Outpatient,,,3.25,2.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.6,80,,2.08,percent of total billed charges,80% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% 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,1.3,40,,1.04,percent of total billed charges,40% of total billed charges,1.21,2.6,
DEMADEX 10MG UD,6400014,CDM,250,RC,,,Outpatient,,,2.4,1.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,80,,1.54,percent of total billed charges,80% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% 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,0.96,40,,0.77,percent of total billed charges,40% of total billed charges,0.89,1.92,
K-DUR 10MEQ,6400014,CDM,250,RC,,,Outpatient,,,2.1,1.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,80,,1.34,percent of total billed charges,80% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% 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,0.84,40,,0.67,percent of total billed charges,40% of total billed charges,0.78,1.68,
PROVERA 2.5MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
DEPAKENE SYRUP,6400014,CDM,250,RC,,,Outpatient,,,15.7,12.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,80,,10.05,percent of total billed charges,80% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% 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,6.28,40,,5.02,percent of total billed charges,40% of total billed charges,5.85,12.56,
CYTOTEC 200MCG TAB,6400014,CDM,250,RC,,,Outpatient,,,4.05,3.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.24,80,,2.59,percent of total billed charges,80% of total billed charges,1.51,37.27,,1.21,percent of total billed charges,37.27% of total billed charges,1.51,37.27,,1.21,percent of total billed charges,37.27% of total billed charges,1.51,37.27,,1.21,percent of total billed charges,37.27% 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,1.62,40,,1.3,percent of total billed charges,40% of total billed charges,1.51,3.24,
VASOTEC 2.5MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,4.95,3.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.96,80,,3.17,percent of total billed charges,80% of total billed charges,1.84,37.27,,1.47,percent of total billed charges,37.27% of total billed charges,1.84,37.27,,1.47,percent of total billed charges,37.27% of total billed charges,1.84,37.27,,1.47,percent of total billed charges,37.27% 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,1.98,40,,1.58,percent of total billed charges,40% of total billed charges,1.84,3.96,
MEGACE 40MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.75,3.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3,80,,2.4,percent of total billed charges,80% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% of total billed charges,1.4,37.27,,1.12,percent of total billed charges,37.27% 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,1.5,40,,1.2,percent of total billed charges,40% of total billed charges,1.4,3,
BENADRYL ELIXIR 5ML,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
TRIDIL AMP 50MG IV,6400014,CDM,250,RC,,,Outpatient,,,46.8,37.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.44,80,,29.95,percent of total billed charges,80% of total billed charges,17.44,37.27,,13.95,percent of total billed charges,37.27% of total billed charges,17.44,37.27,,13.95,percent of total billed charges,37.27% of total billed charges,17.44,37.27,,13.95,percent of total billed charges,37.27% 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,18.72,40,,14.98,percent of total billed charges,40% of total billed charges,17.44,37.44,
MYCOSTATIN TOPICAL 1,6400014,CDM,250,RC,,,Outpatient,,,59.65,47.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.72,80,,38.18,percent of total billed charges,80% of total billed charges,22.23,37.27,,17.78,percent of total billed charges,37.27% of total billed charges,22.23,37.27,,17.78,percent of total billed charges,37.27% of total billed charges,22.23,37.27,,17.78,percent of total billed charges,37.27% 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,23.86,40,,19.09,percent of total billed charges,40% of total billed charges,22.23,47.72,
VASOTEC INJ 1.25MG/M,6400014,CDM,250,RC,,,Outpatient,,,21.7,17.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.36,80,,13.89,percent of total billed charges,80% of total billed charges,8.09,37.27,,6.47,percent of total billed charges,37.27% of total billed charges,8.09,37.27,,6.47,percent of total billed charges,37.27% of total billed charges,8.09,37.27,,6.47,percent of total billed charges,37.27% 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,8.68,40,,6.94,percent of total billed charges,40% of total billed charges,8.09,17.36,
DILANTIN 125 MG/5CC,6065130,CDM,636,RC,J1165,HCPCS,Outpatient,,,2.2,1.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,80,,1.41,percent of total billed charges,80% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% 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,0.88,40,,0.7,percent of total billed charges,40% of total billed charges,0.82,1.76,
ECONOPRED PLUS OPTH-,6400014,CDM,250,RC,,,Outpatient,,,40.45,32.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.36,80,,25.89,percent of total billed charges,80% of total billed charges,15.08,37.27,,12.06,percent of total billed charges,37.27% of total billed charges,15.08,37.27,,12.06,percent of total billed charges,37.27% of total billed charges,15.08,37.27,,12.06,percent of total billed charges,37.27% 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,16.18,40,,12.94,percent of total billed charges,40% of total billed charges,15.08,32.36,
TEMOVATE CREAM 0.05%,6400014,CDM,250,RC,,,Outpatient,,,373.15,298.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,298.52,80,,238.82,percent of total billed charges,80% of total billed charges,139.07,37.27,,111.26,percent of total billed charges,37.27% of total billed charges,139.07,37.27,,111.26,percent of total billed charges,37.27% of total billed charges,139.07,37.27,,111.26,percent of total billed charges,37.27% 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,149.26,40,,119.41,percent of total billed charges,40% of total billed charges,139.07,298.52,
RHINOCORT NASAL SPRA,6400014,CDM,250,RC,,,Outpatient,,,465.55,372.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,372.44,80,,297.95,percent of total billed charges,80% of total billed charges,173.51,37.27,,138.81,percent of total billed charges,37.27% of total billed charges,173.51,37.27,,138.81,percent of total billed charges,37.27% of total billed charges,173.51,37.27,,138.81,percent of total billed charges,37.27% 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,186.22,40,,148.98,percent of total billed charges,40% of total billed charges,173.51,372.44,
CORTAID CREAM 1/2OZ,6400014,CDM,250,RC,,,Outpatient,,,9.85,7.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.88,80,,6.3,percent of total billed charges,80% of total billed charges,3.67,37.27,,2.94,percent of total billed charges,37.27% of total billed charges,3.67,37.27,,2.94,percent of total billed charges,37.27% of total billed charges,3.67,37.27,,2.94,percent of total billed charges,37.27% 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,3.94,40,,3.15,percent of total billed charges,40% of total billed charges,3.67,7.88,
AMPICILLIN INJ 2GM,6065130,CDM,636,RC,J0290,HCPCS,Outpatient,,,19.48,15.58,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.58,80,,12.46,percent of total billed charges,80% of total billed charges,7.26,37.27,,5.81,percent of total billed charges,37.27% of total billed charges,7.26,37.27,,5.81,percent of total billed charges,37.27% of total billed charges,7.26,37.27,,5.81,percent of total billed charges,37.27% 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,7.79,40,,6.23,percent of total billed charges,40% of total billed charges,7.26,15.58,
DACRIOSE OPHTH IRRIG,6400014,CDM,250,RC,,,Outpatient,,,17.85,14.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.28,80,,11.42,percent of total billed charges,80% of total billed charges,6.65,37.27,,5.32,percent of total billed charges,37.27% of total billed charges,6.65,37.27,,5.32,percent of total billed charges,37.27% of total billed charges,6.65,37.27,,5.32,percent of total billed charges,37.27% 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,7.14,40,,5.71,percent of total billed charges,40% of total billed charges,6.65,14.28,
CAMPTOSAR INJ PER 20,6065130,CDM,636,RC,J9206,HCPCS,Outpatient,,,278.94,223.15,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.15,80,,178.52,percent of total billed charges,80% of total billed charges,103.96,37.27,,83.17,percent of total billed charges,37.27% of total billed charges,103.96,37.27,,83.17,percent of total billed charges,37.27% of total billed charges,103.96,37.27,,83.17,percent of total billed charges,37.27% 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,111.58,40,,89.26,percent of total billed charges,40% of total billed charges,103.96,223.15,
TOBRADEX EYE DROPS,6400014,CDM,250,RC,,,Outpatient,,,290.8,232.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,232.64,80,,186.11,percent of total billed charges,80% of total billed charges,108.38,37.27,,86.7,percent of total billed charges,37.27% of total billed charges,108.38,37.27,,86.7,percent of total billed charges,37.27% of total billed charges,108.38,37.27,,86.7,percent of total billed charges,37.27% 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,116.32,40,,93.06,percent of total billed charges,40% of total billed charges,108.38,232.64,
MOBIC 7.5MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,12.15,9.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.72,80,,7.78,percent of total billed charges,80% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% 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,4.86,40,,3.89,percent of total billed charges,40% of total billed charges,4.53,9.72,
PCA STADOL BAG 0.1 M,6400014,CDM,250,RC,,,Outpatient,,,420,336.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336,80,,268.8,percent of total billed charges,80% of total billed charges,156.53,37.27,,125.22,percent of total billed charges,37.27% of total billed charges,156.53,37.27,,125.22,percent of total billed charges,37.27% of total billed charges,156.53,37.27,,125.22,percent of total billed charges,37.27% 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,168,40,,134.4,percent of total billed charges,40% of total billed charges,156.53,336,
REMICADE PER 10 MG,6065130,CDM,636,RC,J1745,HCPCS,Outpatient,,,322.32,257.86,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257.86,80,,206.29,percent of total billed charges,80% of total billed charges,120.13,37.27,,96.1,percent of total billed charges,37.27% of total billed charges,120.13,37.27,,96.1,percent of total billed charges,37.27% of total billed charges,120.13,37.27,,96.1,percent of total billed charges,37.27% of total billed charges,32.22,100,,,fee schedule,100% of APC rate,32.22,100,,,fee schedule,100% of APC rate,32.22,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,32.22,100,,,fee schedule,100% of APC rate,32.22,100,,,fee schedule,100% of APC rate,32.22,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.93,40,,103.14,percent of total billed charges,40% of total billed charges,32.22,257.86,
AGGRENOX CAPSULE SA,6400014,CDM,250,RC,,,Outpatient,,,38.45,30.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.76,80,,24.61,percent of total billed charges,80% of total billed charges,14.33,37.27,,11.46,percent of total billed charges,37.27% of total billed charges,14.33,37.27,,11.46,percent of total billed charges,37.27% of total billed charges,14.33,37.27,,11.46,percent of total billed charges,37.27% 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,15.38,40,,12.3,percent of total billed charges,40% of total billed charges,14.33,30.76,
DITROPAN XL 5MG TABL,6400014,CDM,250,RC,,,Outpatient,,,14.6,11.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.68,80,,9.34,percent of total billed charges,80% of total billed charges,5.44,37.27,,4.35,percent of total billed charges,37.27% of total billed charges,5.44,37.27,,4.35,percent of total billed charges,37.27% of total billed charges,5.44,37.27,,4.35,percent of total billed charges,37.27% 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,5.84,40,,4.67,percent of total billed charges,40% of total billed charges,5.44,11.68,
NOVOLIN 70/30 100U/M,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,64.2,51.36,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.36,80,,41.09,percent of total billed charges,80% of total billed charges,23.93,37.27,,19.14,percent of total billed charges,37.27% of total billed charges,23.93,37.27,,19.14,percent of total billed charges,37.27% of total billed charges,23.93,37.27,,19.14,percent of total billed charges,37.27% 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,25.68,40,,20.54,percent of total billed charges,40% of total billed charges,23.93,51.36,
TUMS TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
SONATA 10MG CAP,6400014,CDM,250,RC,,,Outpatient,,,23.45,18.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.76,80,,15.01,percent of total billed charges,80% of total billed charges,8.74,37.27,,6.99,percent of total billed charges,37.27% of total billed charges,8.74,37.27,,6.99,percent of total billed charges,37.27% of total billed charges,8.74,37.27,,6.99,percent of total billed charges,37.27% 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,9.38,40,,7.5,percent of total billed charges,40% of total billed charges,8.74,18.76,
SONATA 5MG CAP,6400014,CDM,250,RC,,,Outpatient,,,22.85,18.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.28,80,,14.62,percent of total billed charges,80% of total billed charges,8.52,37.27,,6.82,percent of total billed charges,37.27% of total billed charges,8.52,37.27,,6.82,percent of total billed charges,37.27% of total billed charges,8.52,37.27,,6.82,percent of total billed charges,37.27% 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,9.14,40,,7.31,percent of total billed charges,40% of total billed charges,8.52,18.28,
SORBITOL SOLN PER OZ,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
DEBROX EAR DROPS,6400014,CDM,250,RC,,,Outpatient,,,14.7,11.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.76,80,,9.41,percent of total billed charges,80% of total billed charges,5.48,37.27,,4.38,percent of total billed charges,37.27% of total billed charges,5.48,37.27,,4.38,percent of total billed charges,37.27% of total billed charges,5.48,37.27,,4.38,percent of total billed charges,37.27% 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,5.88,40,,4.7,percent of total billed charges,40% of total billed charges,5.48,11.76,
SULF-10 OPTH SOL 15M,6400014,CDM,250,RC,,,Outpatient,,,178.65,142.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.92,80,,114.34,percent of total billed charges,80% of total billed charges,66.58,37.27,,53.26,percent of total billed charges,37.27% of total billed charges,66.58,37.27,,53.26,percent of total billed charges,37.27% of total billed charges,66.58,37.27,,53.26,percent of total billed charges,37.27% 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,71.46,40,,57.17,percent of total billed charges,40% of total billed charges,66.58,142.92,
TOBRADEX OPTH OINT,6400014,CDM,250,RC,,,Outpatient,,,947.15,757.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,757.72,80,,606.18,percent of total billed charges,80% of total billed charges,353,37.27,,282.4,percent of total billed charges,37.27% of total billed charges,353,37.27,,282.4,percent of total billed charges,37.27% of total billed charges,353,37.27,,282.4,percent of total billed charges,37.27% 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,378.86,40,,303.09,percent of total billed charges,40% of total billed charges,353,757.72,
FLANDERS BUTTOCK OIN,6400014,CDM,250,RC,,,Outpatient,,,15.9,12.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.72,80,,10.18,percent of total billed charges,80% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% 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,6.36,40,,5.09,percent of total billed charges,40% of total billed charges,5.93,12.72,
GENTAMICIN OINT 0.1%,6400014,CDM,250,RC,,,Outpatient,,,49.65,39.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.72,80,,31.78,percent of total billed charges,80% of total billed charges,18.5,37.27,,14.8,percent of total billed charges,37.27% of total billed charges,18.5,37.27,,14.8,percent of total billed charges,37.27% of total billed charges,18.5,37.27,,14.8,percent of total billed charges,37.27% 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,19.86,40,,15.89,percent of total billed charges,40% of total billed charges,18.5,39.72,
NITRAZINE PAPER,6400014,CDM,250,RC,,,Outpatient,,,80.55,64.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.44,80,,51.55,percent of total billed charges,80% of total billed charges,30.02,37.27,,24.02,percent of total billed charges,37.27% of total billed charges,30.02,37.27,,24.02,percent of total billed charges,37.27% of total billed charges,30.02,37.27,,24.02,percent of total billed charges,37.27% 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,32.22,40,,25.78,percent of total billed charges,40% of total billed charges,30.02,64.44,
GLUCOAMINE/CHONDR TA,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
SSD CREAM 400GM,6400014,CDM,250,RC,,,Outpatient,,,107.5,86.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86,80,,68.8,percent of total billed charges,80% of total billed charges,40.07,37.27,,32.06,percent of total billed charges,37.27% of total billed charges,40.07,37.27,,32.06,percent of total billed charges,37.27% of total billed charges,40.07,37.27,,32.06,percent of total billed charges,37.27% 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,43,40,,34.4,percent of total billed charges,40% of total billed charges,40.07,86,
WHITE PETROLEUM JELL,6400014,CDM,250,RC,,,Outpatient,,,4.85,3.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.88,80,,3.1,percent of total billed charges,80% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% 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,1.94,40,,1.55,percent of total billed charges,40% of total billed charges,1.81,3.88,
LIDOCAINE OINT 5%,6400014,CDM,250,RC,,,Outpatient,,,25.95,20.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.76,80,,16.61,percent of total billed charges,80% of total billed charges,9.67,37.27,,7.74,percent of total billed charges,37.27% of total billed charges,9.67,37.27,,7.74,percent of total billed charges,37.27% of total billed charges,9.67,37.27,,7.74,percent of total billed charges,37.27% 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,10.38,40,,8.3,percent of total billed charges,40% of total billed charges,9.67,20.76,
REMINYL TAB 4MG,6400014,CDM,250,RC,,,Outpatient,,,9.4,7.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.52,80,,6.02,percent of total billed charges,80% of total billed charges,3.5,37.27,,2.8,percent of total billed charges,37.27% of total billed charges,3.5,37.27,,2.8,percent of total billed charges,37.27% of total billed charges,3.5,37.27,,2.8,percent of total billed charges,37.27% 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,3.76,40,,3.01,percent of total billed charges,40% of total billed charges,3.5,7.52,
STARLIX 120MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,15.25,12.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.2,80,,9.76,percent of total billed charges,80% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.68,37.27,,4.54,percent of total billed charges,37.27% 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,6.1,40,,4.88,percent of total billed charges,40% of total billed charges,5.68,12.2,
HYDROGEN PEROXIDE 8O,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
HYDROGEN PEROXIDE 16,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
SENSORCAINE .25% 30M,6400014,CDM,250,RC,,,Outpatient,,,22.25,17.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.8,80,,14.24,percent of total billed charges,80% of total billed charges,8.29,37.27,,6.63,percent of total billed charges,37.27% of total billed charges,8.29,37.27,,6.63,percent of total billed charges,37.27% of total billed charges,8.29,37.27,,6.63,percent of total billed charges,37.27% 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,8.9,40,,7.12,percent of total billed charges,40% of total billed charges,8.29,17.8,
LIDOCAINE 1% 10MG/ML,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,15,12.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
LIDOCAINE W/EPI,6400014,CDM,250,RC,,,Outpatient,,,28.5,22.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.8,80,,18.24,percent of total billed charges,80% of total billed charges,10.62,37.27,,8.5,percent of total billed charges,37.27% of total billed charges,10.62,37.27,,8.5,percent of total billed charges,37.27% of total billed charges,10.62,37.27,,8.5,percent of total billed charges,37.27% 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,11.4,40,,9.12,percent of total billed charges,40% of total billed charges,10.62,22.8,
LIDOCAINE 2% 20MG/ML,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,16.75,13.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.4,80,,10.72,percent of total billed charges,80% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% 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,6.7,40,,5.36,percent of total billed charges,40% of total billed charges,6.24,13.4,
XYLOCAINE AMP 2% 10M,6400014,CDM,250,RC,,,Outpatient,,,17.05,13.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.64,80,,10.91,percent of total billed charges,80% of total billed charges,6.35,37.27,,5.08,percent of total billed charges,37.27% of total billed charges,6.35,37.27,,5.08,percent of total billed charges,37.27% of total billed charges,6.35,37.27,,5.08,percent of total billed charges,37.27% 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,6.82,40,,5.46,percent of total billed charges,40% of total billed charges,6.35,13.64,
LEVOTHROID 175MCG TA,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
BETADINE DOUCHE CONC,6400014,CDM,250,RC,,,Outpatient,,,30.65,24.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.52,80,,19.62,percent of total billed charges,80% of total billed charges,11.42,37.27,,9.14,percent of total billed charges,37.27% of total billed charges,11.42,37.27,,9.14,percent of total billed charges,37.27% of total billed charges,11.42,37.27,,9.14,percent of total billed charges,37.27% 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,12.26,40,,9.81,percent of total billed charges,40% of total billed charges,11.42,24.52,
FLEETS MINERAL OIL E,5880901,CDM,637,RC,,,Outpatient,,,15.9,12.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.72,80,,10.18,percent of total billed charges,80% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% 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,6.36,40,,5.09,percent of total billed charges,40% of total billed charges,5.93,12.72,
DUPHALAC SYRUP,6400014,CDM,250,RC,,,Outpatient,,,7.85,6.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.28,80,,5.02,percent of total billed charges,80% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% 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,3.14,40,,2.51,percent of total billed charges,40% of total billed charges,2.93,6.28,
DIPHENOXYLATE HCL,6400014,CDM,250,RC,,,Outpatient,,,42.6,34.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.08,80,,27.26,percent of total billed charges,80% of total billed charges,15.88,37.27,,12.7,percent of total billed charges,37.27% of total billed charges,15.88,37.27,,12.7,percent of total billed charges,37.27% of total billed charges,15.88,37.27,,12.7,percent of total billed charges,37.27% 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,17.04,40,,13.63,percent of total billed charges,40% of total billed charges,15.88,34.08,
SOD.POLYSTYRENE SULF,6400014,CDM,250,RC,,,Outpatient,,,113.5,90.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.8,80,,72.64,percent of total billed charges,80% of total billed charges,42.3,37.27,,33.84,percent of total billed charges,37.27% of total billed charges,42.3,37.27,,33.84,percent of total billed charges,37.27% of total billed charges,42.3,37.27,,33.84,percent of total billed charges,37.27% 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,45.4,40,,36.32,percent of total billed charges,40% of total billed charges,42.3,90.8,
POTASS. CL LIQ 20%,6400014,CDM,250,RC,,,Outpatient,,,16.85,13.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.48,80,,10.78,percent of total billed charges,80% of total billed charges,6.28,37.27,,5.02,percent of total billed charges,37.27% of total billed charges,6.28,37.27,,5.02,percent of total billed charges,37.27% of total billed charges,6.28,37.27,,5.02,percent of total billed charges,37.27% 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,6.74,40,,5.39,percent of total billed charges,40% of total billed charges,6.28,13.48,
DIGOXIN ELIXIR,6400014,CDM,250,RC,,,Outpatient,,,438.5,350.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.8,80,,280.64,percent of total billed charges,80% of total billed charges,163.43,37.27,,130.74,percent of total billed charges,37.27% of total billed charges,163.43,37.27,,130.74,percent of total billed charges,37.27% of total billed charges,163.43,37.27,,130.74,percent of total billed charges,37.27% 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,175.4,40,,140.32,percent of total billed charges,40% of total billed charges,163.43,350.8,
DIABETA 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
FIORICET TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
HYDROCHLOROTHIAZIDE,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
INDERAL LA 80MG CAP,6400014,CDM,250,RC,,,Outpatient,,,84.5,67.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.6,80,,54.08,percent of total billed charges,80% of total billed charges,31.49,37.27,,25.19,percent of total billed charges,37.27% of total billed charges,31.49,37.27,,25.19,percent of total billed charges,37.27% of total billed charges,31.49,37.27,,25.19,percent of total billed charges,37.27% 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,33.8,40,,27.04,percent of total billed charges,40% of total billed charges,31.49,67.6,
FUROSEMIDE 20MG TABL,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
MEVACOR 40MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,14.55,11.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.64,80,,9.31,percent of total billed charges,80% of total billed charges,5.42,37.27,,4.34,percent of total billed charges,37.27% of total billed charges,5.42,37.27,,4.34,percent of total billed charges,37.27% of total billed charges,5.42,37.27,,4.34,percent of total billed charges,37.27% 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,5.82,40,,4.66,percent of total billed charges,40% of total billed charges,5.42,11.64,
MEXITIL 200MG CAP,6400014,CDM,250,RC,,,Outpatient,,,10.3,8.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.24,80,,6.59,percent of total billed charges,80% of total billed charges,3.84,37.27,,3.07,percent of total billed charges,37.27% of total billed charges,3.84,37.27,,3.07,percent of total billed charges,37.27% of total billed charges,3.84,37.27,,3.07,percent of total billed charges,37.27% 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,4.12,40,,3.3,percent of total billed charges,40% of total billed charges,3.84,8.24,
OCUVITE TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
METOCLOPRAMINE10 TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
CHLORPROMAZINE,6400014,CDM,250,RC,,,Outpatient,,,75.8,60.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.64,80,,48.51,percent of total billed charges,80% of total billed charges,28.25,37.27,,22.6,percent of total billed charges,37.27% of total billed charges,28.25,37.27,,22.6,percent of total billed charges,37.27% of total billed charges,28.25,37.27,,22.6,percent of total billed charges,37.27% 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,30.32,40,,24.26,percent of total billed charges,40% of total billed charges,28.25,60.64,
TOLAZAMIDE 100MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PERPHENZINE/AMITRIPT,6400014,CDM,250,RC,,,Outpatient,,,7.2,5.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,80,,4.61,percent of total billed charges,80% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% 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,2.88,40,,2.3,percent of total billed charges,40% of total billed charges,2.68,5.76,
VITAMIN C INJ (CENOL,6400014,CDM,250,RC,,,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
ERYTHR. ESTOLATE SUS,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
GLYCERIN SUPP. PEDIA,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
CYANOCOBALAMINE 1MG/,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
DEXAMETHASONE INJ:10,6065130,CDM,636,RC,J1094,HCPCS,Outpatient,,,11.4,9.12,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
NUBAIN 10MG/ML 10ML,6065130,CDM,636,RC,J2300,HCPCS,Outpatient,,,82.75,66.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.2,80,,52.96,percent of total billed charges,80% of total billed charges,30.84,37.27,,24.67,percent of total billed charges,37.27% of total billed charges,30.84,37.27,,24.67,percent of total billed charges,37.27% of total billed charges,30.84,37.27,,24.67,percent of total billed charges,37.27% 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,33.1,40,,26.48,percent of total billed charges,40% of total billed charges,30.84,66.2,
VASOPRESSIN 20U 1ML,6065130,CDM,636,RC,J2598,HCPCS,Outpatient,,,151.4,121.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.12,80,,96.9,percent of total billed charges,80% of total billed charges,56.43,37.27,,45.14,percent of total billed charges,37.27% of total billed charges,56.43,37.27,,45.14,percent of total billed charges,37.27% of total billed charges,56.43,37.27,,45.14,percent of total billed charges,37.27% of total billed charges,1.62,100,,,fee schedule,100% of APC rate,1.62,100,,,fee schedule,100% of APC rate,1.62,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1.62,100,,,fee schedule,100% of APC rate,1.62,100,,,fee schedule,100% of APC rate,1.62,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.56,40,,48.45,percent of total billed charges,40% of total billed charges,1.62,121.12,
NEOSTIGMINE METHYLSU,6065130,CDM,636,RC,J2710,HCPCS,Outpatient,,,58.15,46.52,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.52,80,,37.22,percent of total billed charges,80% of total billed charges,21.67,37.27,,17.34,percent of total billed charges,37.27% of total billed charges,21.67,37.27,,17.34,percent of total billed charges,37.27% of total billed charges,21.67,37.27,,17.34,percent of total billed charges,37.27% 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,23.26,40,,18.61,percent of total billed charges,40% of total billed charges,21.67,46.52,
PROTOMINE SULFATE 25,6065130,CDM,636,RC,J2720,HCPCS,Outpatient,,,49.45,39.56,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.56,80,,31.65,percent of total billed charges,80% of total billed charges,18.43,37.27,,14.74,percent of total billed charges,37.27% of total billed charges,18.43,37.27,,14.74,percent of total billed charges,37.27% of total billed charges,18.43,37.27,,14.74,percent of total billed charges,37.27% 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,19.78,40,,15.82,percent of total billed charges,40% of total billed charges,18.43,39.56,
SODIUM PHOSPHATES 5M,6400014,CDM,250,RC,,,Outpatient,,,99.75,79.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.8,80,,63.84,percent of total billed charges,80% of total billed charges,37.18,37.27,,29.74,percent of total billed charges,37.27% of total billed charges,37.18,37.27,,29.74,percent of total billed charges,37.27% of total billed charges,37.18,37.27,,29.74,percent of total billed charges,37.27% 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,39.9,40,,31.92,percent of total billed charges,40% of total billed charges,37.18,79.8,
STERILE WATER INJ 20,5645742,CDM,270,RC,,,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
BACTERIOSTATIC SOD C,6400014,CDM,250,RC,,,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
GELFILM,5880901,CDM,637,RC,,,Outpatient,,,865.85,692.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,692.68,80,,554.14,percent of total billed charges,80% of total billed charges,322.7,37.27,,258.16,percent of total billed charges,37.27% of total billed charges,322.7,37.27,,258.16,percent of total billed charges,37.27% of total billed charges,322.7,37.27,,258.16,percent of total billed charges,37.27% 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,346.34,40,,277.07,percent of total billed charges,40% of total billed charges,322.7,692.68,
LIPOSYN II 10 %,6400014,CDM,250,RC,,,Outpatient,,,186.55,149.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.24,80,,119.39,percent of total billed charges,80% of total billed charges,69.53,37.27,,55.62,percent of total billed charges,37.27% of total billed charges,69.53,37.27,,55.62,percent of total billed charges,37.27% of total billed charges,69.53,37.27,,55.62,percent of total billed charges,37.27% 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,74.62,40,,59.7,percent of total billed charges,40% of total billed charges,69.53,149.24,
HIBICLENS CLEANER 8,5645742,CDM,270,RC,,,Outpatient,,,19.15,15.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.32,80,,12.26,percent of total billed charges,80% of total billed charges,7.14,37.27,,5.71,percent of total billed charges,37.27% of total billed charges,7.14,37.27,,5.71,percent of total billed charges,37.27% of total billed charges,7.14,37.27,,5.71,percent of total billed charges,37.27% 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,7.66,40,,6.13,percent of total billed charges,40% of total billed charges,7.14,15.32,
HIBICLENS CLEANER 16,5645742,CDM,270,RC,,,Outpatient,,,23.25,18.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.6,80,,14.88,percent of total billed charges,80% of total billed charges,8.67,37.27,,6.94,percent of total billed charges,37.27% of total billed charges,8.67,37.27,,6.94,percent of total billed charges,37.27% of total billed charges,8.67,37.27,,6.94,percent of total billed charges,37.27% 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,9.3,40,,7.44,percent of total billed charges,40% of total billed charges,8.67,18.6,
HIBICLENS CLEANER 32,5645742,CDM,270,RC,,,Outpatient,,,37.5,30.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,80,,24,percent of total billed charges,80% of total billed charges,13.98,37.27,,11.18,percent of total billed charges,37.27% of total billed charges,13.98,37.27,,11.18,percent of total billed charges,37.27% of total billed charges,13.98,37.27,,11.18,percent of total billed charges,37.27% 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,15,40,,12,percent of total billed charges,40% of total billed charges,13.98,30,
HEPARIN FLUSH 100U 1,6065130,CDM,636,RC,J1642,HCPCS,Outpatient,,,22.9,18.32,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.32,80,,14.66,percent of total billed charges,80% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% 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,9.16,40,,7.33,percent of total billed charges,40% of total billed charges,8.53,18.32,
HYDROXYZINE 50MG/ML,6065130,CDM,636,RC,J3410,HCPCS,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
VANCOMYCIN IV 1G,6065130,CDM,636,RC,J3370,HCPCS,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
DOXYCYCLINE HYCLATE,6400014,CDM,250,RC,,,Outpatient,,,48.65,38.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.92,80,,31.14,percent of total billed charges,80% of total billed charges,18.13,37.27,,14.5,percent of total billed charges,37.27% of total billed charges,18.13,37.27,,14.5,percent of total billed charges,37.27% of total billed charges,18.13,37.27,,14.5,percent of total billed charges,37.27% 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,19.46,40,,15.57,percent of total billed charges,40% of total billed charges,18.13,38.92,
CLAFORAN ADDVANTAGE,6065130,CDM,636,RC,J0698,HCPCS,Outpatient,,,59.8,47.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.84,80,,38.27,percent of total billed charges,80% of total billed charges,22.29,37.27,,17.83,percent of total billed charges,37.27% of total billed charges,22.29,37.27,,17.83,percent of total billed charges,37.27% of total billed charges,22.29,37.27,,17.83,percent of total billed charges,37.27% 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,23.92,40,,19.14,percent of total billed charges,40% of total billed charges,22.29,47.84,
AQUAPHOR OINT BASE,6400014,CDM,250,RC,,,Outpatient,,,76.85,61.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.48,80,,49.18,percent of total billed charges,80% of total billed charges,28.64,37.27,,22.91,percent of total billed charges,37.27% of total billed charges,28.64,37.27,,22.91,percent of total billed charges,37.27% of total billed charges,28.64,37.27,,22.91,percent of total billed charges,37.27% 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,30.74,40,,24.59,percent of total billed charges,40% of total billed charges,28.64,61.48,
ATIVAN INJ 2MG VL,6065130,CDM,636,RC,J2060,HCPCS,Outpatient,,,43.7,34.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.96,80,,27.97,percent of total billed charges,80% of total billed charges,16.29,37.27,,13.03,percent of total billed charges,37.27% of total billed charges,16.29,37.27,,13.03,percent of total billed charges,37.27% of total billed charges,16.29,37.27,,13.03,percent of total billed charges,37.27% 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,17.48,40,,13.98,percent of total billed charges,40% of total billed charges,16.29,34.96,
SULINDAC TAB 200MG 1,6400014,CDM,250,RC,,,Outpatient,,,4.1,3.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.28,80,,2.62,percent of total billed charges,80% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% 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,1.64,40,,1.31,percent of total billed charges,40% of total billed charges,1.53,3.28,
MIDRIN CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
DOBUTREX 250MG 20ML,6065130,CDM,636,RC,J1250,HCPCS,Outpatient,,,184.55,147.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.64,80,,118.11,percent of total billed charges,80% of total billed charges,68.78,37.27,,55.02,percent of total billed charges,37.27% of total billed charges,68.78,37.27,,55.02,percent of total billed charges,37.27% of total billed charges,68.78,37.27,,55.02,percent of total billed charges,37.27% 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,73.82,40,,59.06,percent of total billed charges,40% of total billed charges,68.78,147.64,
LIPOSYN II 20% 500ML,6400014,CDM,250,RC,,,Outpatient,,,265.56,212.45,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,212.45,80,,169.96,percent of total billed charges,80% of total billed charges,98.97,37.27,,79.18,percent of total billed charges,37.27% of total billed charges,98.97,37.27,,79.18,percent of total billed charges,37.27% of total billed charges,98.97,37.27,,79.18,percent of total billed charges,37.27% 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,106.22,40,,84.98,percent of total billed charges,40% of total billed charges,98.97,212.45,
CEPASTAT LOZ,6400014,CDM,250,RC,,,Outpatient,,,13.4,10.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.72,80,,8.58,percent of total billed charges,80% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% 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,5.36,40,,4.29,percent of total billed charges,40% of total billed charges,4.99,10.72,
MAGNESIUM SULFATE 1G,6065130,CDM,636,RC,J3475,HCPCS,Outpatient,,,11.4,9.12,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
PHENOBARBITAL TAB 60,6400014,CDM,250,RC,,,Outpatient,,,2.95,2.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,80,,1.89,percent of total billed charges,80% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% 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,1.18,40,,0.94,percent of total billed charges,40% of total billed charges,1.1,2.36,
SULFASALAZINE 500MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
BETOPTIC S OPHTH SOL,6400014,CDM,250,RC,,,Outpatient,,,168.25,134.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.6,80,,107.68,percent of total billed charges,80% of total billed charges,62.71,37.27,,50.17,percent of total billed charges,37.27% of total billed charges,62.71,37.27,,50.17,percent of total billed charges,37.27% of total billed charges,62.71,37.27,,50.17,percent of total billed charges,37.27% 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,67.3,40,,53.84,percent of total billed charges,40% of total billed charges,62.71,134.6,
CYCLOBENZAPRINE 10MG,6400014,CDM,250,RC,,,Outpatient,,,3.25,2.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.6,80,,2.08,percent of total billed charges,80% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% 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,1.3,40,,1.04,percent of total billed charges,40% of total billed charges,1.21,2.6,
Z BEC TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ADVIL TAB 200MG UD,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
AMINOSYN II 8.5%,6400014,CDM,250,RC,,,Outpatient,,,199.8,159.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.84,80,,127.87,percent of total billed charges,80% of total billed charges,74.47,37.27,,59.58,percent of total billed charges,37.27% of total billed charges,74.47,37.27,,59.58,percent of total billed charges,37.27% of total billed charges,74.47,37.27,,59.58,percent of total billed charges,37.27% 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,79.92,40,,63.94,percent of total billed charges,40% of total billed charges,74.47,159.84,
AMITRIPTYLING 25MG T,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
RENO M 60 50CC,6000905,CDM,255,RC,,,Outpatient,,,29.75,23.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.8,80,,19.04,percent of total billed charges,80% of total billed charges,11.09,37.27,,8.87,percent of total billed charges,37.27% of total billed charges,11.09,37.27,,8.87,percent of total billed charges,37.27% of total billed charges,11.09,37.27,,8.87,percent of total billed charges,37.27% 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,11.9,40,,9.52,percent of total billed charges,40% of total billed charges,11.09,23.8,
ACCUPRIL 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,6.05,4.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,80,,3.87,percent of total billed charges,80% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% 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,2.42,40,,1.94,percent of total billed charges,40% of total billed charges,2.25,4.84,
ROMAZICON 0.5MG/5ML,6400014,CDM,250,RC,,,Outpatient,,,111,88.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% 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,44.4,40,,35.52,percent of total billed charges,40% of total billed charges,41.37,88.8,
ANAPROX DS 550MG,6400014,CDM,250,RC,,,Outpatient,,,4.3,3.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.44,80,,2.75,percent of total billed charges,80% of total billed charges,1.6,37.27,,1.28,percent of total billed charges,37.27% of total billed charges,1.6,37.27,,1.28,percent of total billed charges,37.27% of total billed charges,1.6,37.27,,1.28,percent of total billed charges,37.27% 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,1.72,40,,1.38,percent of total billed charges,40% of total billed charges,1.6,3.44,
PERPHENZAZINE 4MG,6400014,CDM,250,RC,,,Outpatient,,,9.15,7.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.32,80,,5.86,percent of total billed charges,80% of total billed charges,3.41,37.27,,2.73,percent of total billed charges,37.27% of total billed charges,3.41,37.27,,2.73,percent of total billed charges,37.27% of total billed charges,3.41,37.27,,2.73,percent of total billed charges,37.27% 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,3.66,40,,2.93,percent of total billed charges,40% of total billed charges,3.41,7.32,
CARDIZEM CD 180MG,6400014,CDM,250,RC,,,Outpatient,,,4.75,3.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.8,80,,3.04,percent of total billed charges,80% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% 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,1.9,40,,1.52,percent of total billed charges,40% of total billed charges,1.77,3.8,
DYNACIRC CAPS 2.5MG,6400014,CDM,250,RC,,,Outpatient,,,1.8,1.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.44,80,,1.15,percent of total billed charges,80% of total billed charges,0.67,37.27,,0.54,percent of total billed charges,37.27% of total billed charges,0.67,37.27,,0.54,percent of total billed charges,37.27% of total billed charges,0.67,37.27,,0.54,percent of total billed charges,37.27% 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,0.72,40,,0.58,percent of total billed charges,40% of total billed charges,0.67,1.44,
ERGOLOID MESYLATE TA,6400014,CDM,250,RC,,,Outpatient,,,39.3,31.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.44,80,,25.15,percent of total billed charges,80% of total billed charges,14.65,37.27,,11.72,percent of total billed charges,37.27% of total billed charges,14.65,37.27,,11.72,percent of total billed charges,37.27% of total billed charges,14.65,37.27,,11.72,percent of total billed charges,37.27% 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,15.72,40,,12.58,percent of total billed charges,40% of total billed charges,14.65,31.44,
CILOXAN OPHTH SOLN,6400014,CDM,250,RC,,,Outpatient,,,72.95,58.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.36,80,,46.69,percent of total billed charges,80% of total billed charges,27.19,37.27,,21.75,percent of total billed charges,37.27% of total billed charges,27.19,37.27,,21.75,percent of total billed charges,37.27% of total billed charges,27.19,37.27,,21.75,percent of total billed charges,37.27% 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,29.18,40,,23.34,percent of total billed charges,40% of total billed charges,27.19,58.36,
ZOLOFT 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,10.4,8.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,80,,6.66,percent of total billed charges,80% of total billed charges,3.88,37.27,,3.1,percent of total billed charges,37.27% of total billed charges,3.88,37.27,,3.1,percent of total billed charges,37.27% of total billed charges,3.88,37.27,,3.1,percent of total billed charges,37.27% 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,4.16,40,,3.33,percent of total billed charges,40% of total billed charges,3.88,8.32,
BEANO,6400014,CDM,250,RC,,,Outpatient,,,4.9,3.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.92,80,,3.14,percent of total billed charges,80% of total billed charges,1.83,37.27,,1.46,percent of total billed charges,37.27% of total billed charges,1.83,37.27,,1.46,percent of total billed charges,37.27% of total billed charges,1.83,37.27,,1.46,percent of total billed charges,37.27% 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,1.96,40,,1.57,percent of total billed charges,40% of total billed charges,1.83,3.92,
ZITHROMAX 250MG CAPS,6400014,CDM,250,RC,,,Outpatient,,,31.3,25.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.04,80,,20.03,percent of total billed charges,80% of total billed charges,11.67,37.27,,9.34,percent of total billed charges,37.27% of total billed charges,11.67,37.27,,9.34,percent of total billed charges,37.27% of total billed charges,11.67,37.27,,9.34,percent of total billed charges,37.27% 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,12.52,40,,10.02,percent of total billed charges,40% of total billed charges,11.67,25.04,
ROWASA SUPP 500MG,6400014,CDM,250,RC,,,Outpatient,,,9.3,7.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.44,80,,5.95,percent of total billed charges,80% of total billed charges,3.47,37.27,,2.78,percent of total billed charges,37.27% of total billed charges,3.47,37.27,,2.78,percent of total billed charges,37.27% of total billed charges,3.47,37.27,,2.78,percent of total billed charges,37.27% 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,3.72,40,,2.98,percent of total billed charges,40% of total billed charges,3.47,7.44,
NEUPOGEN 300MCG/ML,6065130,CDM,636,RC,J1442,HCPCS,Outpatient,,,1072.7,858.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,858.16,80,,686.53,percent of total billed charges,80% of total billed charges,399.8,37.27,,319.84,percent of total billed charges,37.27% of total billed charges,399.8,37.27,,319.84,percent of total billed charges,37.27% of total billed charges,399.8,37.27,,319.84,percent of total billed charges,37.27% of total billed charges,1,100,,,fee schedule,100% of APC rate,1,100,,,fee schedule,100% of APC rate,1,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1,100,,,fee schedule,100% of APC rate,1,100,,,fee schedule,100% of APC rate,1,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,429.08,40,,343.26,percent of total billed charges,40% of total billed charges,1,858.16,
SOD CIT/CIT ACI 30CC,6400014,CDM,250,RC,,,Outpatient,,,18.85,15.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.08,80,,12.06,percent of total billed charges,80% of total billed charges,7.03,37.27,,5.62,percent of total billed charges,37.27% of total billed charges,7.03,37.27,,5.62,percent of total billed charges,37.27% of total billed charges,7.03,37.27,,5.62,percent of total billed charges,37.27% 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,7.54,40,,6.03,percent of total billed charges,40% of total billed charges,7.03,15.08,
MIVACRON INJ 2MG/ML,6400014,CDM,250,RC,,,Outpatient,,,63.3,50.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.64,80,,40.51,percent of total billed charges,80% of total billed charges,23.59,37.27,,18.87,percent of total billed charges,37.27% of total billed charges,23.59,37.27,,18.87,percent of total billed charges,37.27% of total billed charges,23.59,37.27,,18.87,percent of total billed charges,37.27% 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,25.32,40,,20.26,percent of total billed charges,40% of total billed charges,23.59,50.64,
ZOCOR-10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,10.3,8.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.24,80,,6.59,percent of total billed charges,80% of total billed charges,3.84,37.27,,3.07,percent of total billed charges,37.27% of total billed charges,3.84,37.27,,3.07,percent of total billed charges,37.27% of total billed charges,3.84,37.27,,3.07,percent of total billed charges,37.27% 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,4.12,40,,3.3,percent of total billed charges,40% of total billed charges,3.84,8.24,
ZOVIRAX SUSP 200MG/5,6400014,CDM,250,RC,,,Outpatient,,,25,20.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% 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,10,40,,8,percent of total billed charges,40% of total billed charges,9.32,20,
THEO-24 300MG CAP,6400014,CDM,250,RC,,,Outpatient,,,26.3,21.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.04,80,,16.83,percent of total billed charges,80% of total billed charges,9.8,37.27,,7.84,percent of total billed charges,37.27% of total billed charges,9.8,37.27,,7.84,percent of total billed charges,37.27% of total billed charges,9.8,37.27,,7.84,percent of total billed charges,37.27% 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,10.52,40,,8.42,percent of total billed charges,40% of total billed charges,9.8,21.04,
XYLOCAINE TOP SOL 4%,6400014,CDM,250,RC,,,Outpatient,,,47.7,38.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.16,80,,30.53,percent of total billed charges,80% of total billed charges,17.78,37.27,,14.22,percent of total billed charges,37.27% of total billed charges,17.78,37.27,,14.22,percent of total billed charges,37.27% of total billed charges,17.78,37.27,,14.22,percent of total billed charges,37.27% 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,19.08,40,,15.26,percent of total billed charges,40% of total billed charges,17.78,38.16,
CARDIZEM CD 300MG CA,6400014,CDM,250,RC,,,Outpatient,,,193.9,155.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.12,80,,124.1,percent of total billed charges,80% of total billed charges,72.27,37.27,,57.82,percent of total billed charges,37.27% of total billed charges,72.27,37.27,,57.82,percent of total billed charges,37.27% of total billed charges,72.27,37.27,,57.82,percent of total billed charges,37.27% 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,77.56,40,,62.05,percent of total billed charges,40% of total billed charges,72.27,155.12,
CARDIZEM 50MG VIAL,6400014,CDM,250,RC,,,Outpatient,,,87.95,70.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.36,80,,56.29,percent of total billed charges,80% of total billed charges,32.78,37.27,,26.22,percent of total billed charges,37.27% of total billed charges,32.78,37.27,,26.22,percent of total billed charges,37.27% of total billed charges,32.78,37.27,,26.22,percent of total billed charges,37.27% 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,35.18,40,,28.14,percent of total billed charges,40% of total billed charges,32.78,70.36,
TOPROL-XL 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,4.2,3.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.36,80,,2.69,percent of total billed charges,80% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% 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,1.68,40,,1.34,percent of total billed charges,40% of total billed charges,1.57,3.36,
LANOLIN 1 3/4 OZ,6400014,CDM,250,RC,,,Outpatient,,,43.9,35.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.12,80,,28.1,percent of total billed charges,80% of total billed charges,16.36,37.27,,13.09,percent of total billed charges,37.27% of total billed charges,16.36,37.27,,13.09,percent of total billed charges,37.27% of total billed charges,16.36,37.27,,13.09,percent of total billed charges,37.27% 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,17.56,40,,14.05,percent of total billed charges,40% of total billed charges,16.36,35.12,
ENGERIX-B 20MCG VL,6065130,CDM,636,RC,90746,HCPCS,Outpatient,,,283.8,227.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,227.04,80,,181.63,percent of total billed charges,80% of total billed charges,105.77,37.27,,84.62,percent of total billed charges,37.27% of total billed charges,105.77,37.27,,84.62,percent of total billed charges,37.27% of total billed charges,105.77,37.27,,84.62,percent of total billed charges,37.27% 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,113.52,40,,90.82,percent of total billed charges,40% of total billed charges,105.77,227.04,
ZESTRIL 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,4.5,3.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,80,,2.88,percent of total billed charges,80% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% 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,1.8,40,,1.44,percent of total billed charges,40% of total billed charges,1.68,3.6,
DIPORLENE AF,6400014,CDM,250,RC,,,Outpatient,,,64.5,51.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.6,80,,41.28,percent of total billed charges,80% of total billed charges,24.04,37.27,,19.23,percent of total billed charges,37.27% of total billed charges,24.04,37.27,,19.23,percent of total billed charges,37.27% of total billed charges,24.04,37.27,,19.23,percent of total billed charges,37.27% 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,25.8,40,,20.64,percent of total billed charges,40% of total billed charges,24.04,51.6,
THEO-24 200MG,6400014,CDM,250,RC,,,Outpatient,,,21.4,17.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.12,80,,13.7,percent of total billed charges,80% of total billed charges,7.98,37.27,,6.38,percent of total billed charges,37.27% of total billed charges,7.98,37.27,,6.38,percent of total billed charges,37.27% of total billed charges,7.98,37.27,,6.38,percent of total billed charges,37.27% 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,8.56,40,,6.85,percent of total billed charges,40% of total billed charges,7.98,17.12,
CENTRUM LIQUID MULTI,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
ORAP-2MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2,1.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
MOTRIN SUSP 5CC(100M,5880901,CDM,637,RC,,,Outpatient,,,3.5,2.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
PRENATE 90 TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ACCUPRIL 10MG TAB U/,6400014,CDM,250,RC,,,Outpatient,,,6.05,4.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,80,,3.87,percent of total billed charges,80% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% 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,2.42,40,,1.94,percent of total billed charges,40% of total billed charges,2.25,4.84,
PROSCAR 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,11.45,9.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.16,80,,7.33,percent of total billed charges,80% of total billed charges,4.27,37.27,,3.42,percent of total billed charges,37.27% of total billed charges,4.27,37.27,,3.42,percent of total billed charges,37.27% of total billed charges,4.27,37.27,,3.42,percent of total billed charges,37.27% 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,4.58,40,,3.66,percent of total billed charges,40% of total billed charges,4.27,9.16,
ENGERIX-B 10MCG/0.5M,6400014,CDM,250,RC,,,Outpatient,,,112.95,90.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.36,80,,72.29,percent of total billed charges,80% of total billed charges,42.1,37.27,,33.68,percent of total billed charges,37.27% of total billed charges,42.1,37.27,,33.68,percent of total billed charges,37.27% of total billed charges,42.1,37.27,,33.68,percent of total billed charges,37.27% 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,45.18,40,,36.14,percent of total billed charges,40% of total billed charges,42.1,90.36,
METROGEL 1PZ TUBE,6400014,CDM,250,RC,,,Outpatient,,,54.5,43.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.6,80,,34.88,percent of total billed charges,80% of total billed charges,20.31,37.27,,16.25,percent of total billed charges,37.27% of total billed charges,20.31,37.27,,16.25,percent of total billed charges,37.27% of total billed charges,20.31,37.27,,16.25,percent of total billed charges,37.27% 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,21.8,40,,17.44,percent of total billed charges,40% of total billed charges,20.31,43.6,
BUTALBITAL/APAP/CAFF,6400014,CDM,250,RC,,,Outpatient,,,6.9,5.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.52,80,,4.42,percent of total billed charges,80% of total billed charges,2.57,37.27,,2.06,percent of total billed charges,37.27% of total billed charges,2.57,37.27,,2.06,percent of total billed charges,37.27% of total billed charges,2.57,37.27,,2.06,percent of total billed charges,37.27% 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,2.76,40,,2.21,percent of total billed charges,40% of total billed charges,2.57,5.52,
URIMAR-T,6400014,CDM,250,RC,,,Outpatient,,,17.8,14.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.24,80,,11.39,percent of total billed charges,80% of total billed charges,6.63,37.27,,5.3,percent of total billed charges,37.27% of total billed charges,6.63,37.27,,5.3,percent of total billed charges,37.27% of total billed charges,6.63,37.27,,5.3,percent of total billed charges,37.27% 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,7.12,40,,5.7,percent of total billed charges,40% of total billed charges,6.63,14.24,
ALBUTEROL INH SOLN U,6400014,CDM,250,RC,,,Outpatient,,,4.75,3.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.8,80,,3.04,percent of total billed charges,80% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% 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,1.9,40,,1.52,percent of total billed charges,40% of total billed charges,1.77,3.8,
PROPOXY-N APAP TAB 1,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
METHOCARBAMOL 500MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
DIPHENHYDR 50MG INJ,6400014,CDM,250,RC,J1200,HCPCS,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
IMDUR 30MG TAB,6400014,CDM,250,RC,,,Outpatient,,,4.05,3.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.24,80,,2.59,percent of total billed charges,80% of total billed charges,1.51,37.27,,1.21,percent of total billed charges,37.27% of total billed charges,1.51,37.27,,1.21,percent of total billed charges,37.27% of total billed charges,1.51,37.27,,1.21,percent of total billed charges,37.27% 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,1.62,40,,1.3,percent of total billed charges,40% of total billed charges,1.51,3.24,
VICOPROFEN 7.5 MG/20,6400014,CDM,250,RC,,,Outpatient,,,4,3.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
PCA STACOL BAG 0.2MG,6400014,CDM,250,RC,,,Outpatient,,,420.02,336.02,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336.02,80,,268.82,percent of total billed charges,80% of total billed charges,156.54,37.27,,125.23,percent of total billed charges,37.27% of total billed charges,156.54,37.27,,125.23,percent of total billed charges,37.27% of total billed charges,156.54,37.27,,125.23,percent of total billed charges,37.27% 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,168.01,40,,134.41,percent of total billed charges,40% of total billed charges,156.54,336.02,
PCA FENT 5 MCG/ML-MA,6400014,CDM,250,RC,,,Outpatient,,,163.73,130.98,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.98,80,,104.78,percent of total billed charges,80% of total billed charges,61.02,37.27,,48.82,percent of total billed charges,37.27% of total billed charges,61.02,37.27,,48.82,percent of total billed charges,37.27% of total billed charges,61.02,37.27,,48.82,percent of total billed charges,37.27% 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,65.49,40,,52.39,percent of total billed charges,40% of total billed charges,61.02,130.98,
EXELON 1.5MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,15.7,12.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,80,,10.05,percent of total billed charges,80% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% 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,6.28,40,,5.02,percent of total billed charges,40% of total billed charges,5.85,12.56,
DIAZEPAM 5MG/ML VIAL,6065130,CDM,636,RC,J3360,HCPCS,Outpatient,,,11.4,9.12,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
LOVENOX INJ 40MG/0.4,6065130,CDM,636,RC,J1650,HCPCS,Outpatient,,,123.05,98.44,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.44,80,,78.75,percent of total billed charges,80% of total billed charges,45.86,37.27,,36.69,percent of total billed charges,37.27% of total billed charges,45.86,37.27,,36.69,percent of total billed charges,37.27% of total billed charges,45.86,37.27,,36.69,percent of total billed charges,37.27% 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,49.22,40,,39.38,percent of total billed charges,40% of total billed charges,45.86,98.44,
ZOCOR 40MG TAB,6400014,CDM,250,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
GUANFACINE 1MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,3.4,2.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.72,80,,2.18,percent of total billed charges,80% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% 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,1.36,40,,1.09,percent of total billed charges,40% of total billed charges,1.27,2.72,
12 HOUR NASAL SPRAY,6400014,CDM,250,RC,,,Outpatient,,,13.4,10.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.72,80,,8.58,percent of total billed charges,80% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% 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,5.36,40,,4.29,percent of total billed charges,40% of total billed charges,4.99,10.72,
TNKASE 50MG KIT,6065130,CDM,636,RC,J3101,HCPCS,Outpatient,,,432.08,345.66,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.66,80,,276.53,percent of total billed charges,80% of total billed charges,161.04,37.27,,128.83,percent of total billed charges,37.27% of total billed charges,161.04,37.27,,128.83,percent of total billed charges,37.27% of total billed charges,161.04,37.27,,128.83,percent of total billed charges,37.27% of total billed charges,157.72,100,,,fee schedule,100% of APC rate,157.72,100,,,fee schedule,100% of APC rate,157.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,157.72,100,,,fee schedule,100% of APC rate,157.72,100,,,fee schedule,100% of APC rate,157.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.83,40,,138.26,percent of total billed charges,40% of total billed charges,157.72,345.66,
DETROL LA 2MG CAPSUL,6400014,CDM,250,RC,,,Outpatient,,,56.2,44.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.96,80,,35.97,percent of total billed charges,80% of total billed charges,20.95,37.27,,16.76,percent of total billed charges,37.27% of total billed charges,20.95,37.27,,16.76,percent of total billed charges,37.27% of total billed charges,20.95,37.27,,16.76,percent of total billed charges,37.27% 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,22.48,40,,17.98,percent of total billed charges,40% of total billed charges,20.95,44.96,
EFFEXOR XR 75MG CAPS,6400014,CDM,250,RC,,,Outpatient,,,19.8,15.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.84,80,,12.67,percent of total billed charges,80% of total billed charges,7.38,37.27,,5.9,percent of total billed charges,37.27% of total billed charges,7.38,37.27,,5.9,percent of total billed charges,37.27% of total billed charges,7.38,37.27,,5.9,percent of total billed charges,37.27% 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,7.92,40,,6.34,percent of total billed charges,40% of total billed charges,7.38,15.84,
ALOCRIL 2% EYE DROPS,6400014,CDM,250,RC,,,Outpatient,,,470.45,376.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,376.36,80,,301.09,percent of total billed charges,80% of total billed charges,175.34,37.27,,140.27,percent of total billed charges,37.27% of total billed charges,175.34,37.27,,140.27,percent of total billed charges,37.27% of total billed charges,175.34,37.27,,140.27,percent of total billed charges,37.27% 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,188.18,40,,150.54,percent of total billed charges,40% of total billed charges,175.34,376.36,
LUPRON DEPOT 22.5MG,6065130,CDM,636,RC,J1950,HCPCS,Outpatient,,,6175.52,4940.42,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4940.42,80,,3952.34,percent of total billed charges,80% of total billed charges,2301.62,37.27,,1841.3,percent of total billed charges,37.27% of total billed charges,2301.62,37.27,,1841.3,percent of total billed charges,37.27% of total billed charges,2301.62,37.27,,1841.3,percent of total billed charges,37.27% of total billed charges,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2470.21,40,,1976.17,percent of total billed charges,40% of total billed charges,1617.65,4940.42,
IMITREX 6MG/0.5ML,6065130,CDM,636,RC,J3030,HCPCS,Outpatient,,,364.3,291.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,291.44,80,,233.15,percent of total billed charges,80% of total billed charges,135.77,37.27,,108.62,percent of total billed charges,37.27% of total billed charges,135.77,37.27,,108.62,percent of total billed charges,37.27% of total billed charges,135.77,37.27,,108.62,percent of total billed charges,37.27% 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,145.72,40,,116.58,percent of total billed charges,40% of total billed charges,135.77,291.44,
DILTIAZEM 60MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,2.4,1.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,80,,1.54,percent of total billed charges,80% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% 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,0.96,40,,0.77,percent of total billed charges,40% of total billed charges,0.89,1.92,
DURATUSS HD ELIXIR,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
FORTAZ 2GM IV ADVANT,6065130,CDM,636,RC,J0713,HCPCS,Outpatient,,,125.8,100.64,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.64,80,,80.51,percent of total billed charges,80% of total billed charges,46.89,37.27,,37.51,percent of total billed charges,37.27% of total billed charges,46.89,37.27,,37.51,percent of total billed charges,37.27% of total billed charges,46.89,37.27,,37.51,percent of total billed charges,37.27% 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,50.32,40,,40.26,percent of total billed charges,40% of total billed charges,46.89,100.64,
FLOVENT 110MCG INHAL,6400014,CDM,250,RC,,,Outpatient,,,166,132.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,61.87,37.27,,49.5,percent of total billed charges,37.27% of total billed charges,61.87,37.27,,49.5,percent of total billed charges,37.27% of total billed charges,61.87,37.27,,49.5,percent of total billed charges,37.27% 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,66.4,40,,53.12,percent of total billed charges,40% of total billed charges,61.87,132.8,
QUININE SULFATE 200M,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
BISOP/HCTZ TB 10/6.2,6400014,CDM,250,RC,,,Outpatient,,,3.9,3.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.12,80,,2.5,percent of total billed charges,80% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% 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,1.56,40,,1.25,percent of total billed charges,40% of total billed charges,1.45,3.12,
EPOETIN(>10KU) 1000U,6065130,CDM,636,RC,J0885,HCPCS,Outpatient,,,50.2,40.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.16,80,,32.13,percent of total billed charges,80% of total billed charges,18.71,37.27,,14.97,percent of total billed charges,37.27% of total billed charges,18.71,37.27,,14.97,percent of total billed charges,37.27% of total billed charges,18.71,37.27,,14.97,percent of total billed charges,37.27% of total billed charges,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.08,40,,16.06,percent of total billed charges,40% of total billed charges,7.53,40.16,
TIAZAC 300MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,7.21,5.77,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.77,80,,4.62,percent of total billed charges,80% of total billed charges,2.69,37.27,,2.15,percent of total billed charges,37.27% of total billed charges,2.69,37.27,,2.15,percent of total billed charges,37.27% of total billed charges,2.69,37.27,,2.15,percent of total billed charges,37.27% 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,2.88,40,,2.3,percent of total billed charges,40% of total billed charges,2.69,5.77,
INTRALIPID 10% IV FA,6400014,CDM,250,RC,,,Outpatient,,,207.2,165.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165.76,80,,132.61,percent of total billed charges,80% of total billed charges,77.22,37.27,,61.78,percent of total billed charges,37.27% of total billed charges,77.22,37.27,,61.78,percent of total billed charges,37.27% of total billed charges,77.22,37.27,,61.78,percent of total billed charges,37.27% 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,82.88,40,,66.3,percent of total billed charges,40% of total billed charges,77.22,165.76,
INTRALIPID 20% IV FA,6400014,CDM,250,RC,,,Outpatient,,,233.15,186.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186.52,80,,149.22,percent of total billed charges,80% of total billed charges,86.9,37.27,,69.52,percent of total billed charges,37.27% of total billed charges,86.9,37.27,,69.52,percent of total billed charges,37.27% of total billed charges,86.9,37.27,,69.52,percent of total billed charges,37.27% 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,93.26,40,,74.61,percent of total billed charges,40% of total billed charges,86.9,186.52,
AMOXICILLIN 500MG CA,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
TAPAZOLE 5MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
LOTENSIN HCT TAB 20/,6400014,CDM,250,RC,,,Outpatient,,,2.1,1.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,80,,1.34,percent of total billed charges,80% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% 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,0.84,40,,0.67,percent of total billed charges,40% of total billed charges,0.78,1.68,
IBERET-FOLIC TAB,6400014,CDM,250,RC,,,Outpatient,,,2.02,1.62,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.62,80,,1.3,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.81,40,,0.65,percent of total billed charges,40% of total billed charges,0.75,1.62,
ACETIC ACID SOLN 0.2,6400014,CDM,250,RC,,,Outpatient,,,4.85,3.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.88,80,,3.1,percent of total billed charges,80% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% 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,1.94,40,,1.55,percent of total billed charges,40% of total billed charges,1.81,3.88,
EVISTA 60MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% 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,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,10.06,21.6,
AZOPT (CARBONIC ANHY,6400014,CDM,250,RC,,,Outpatient,,,599.3,479.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,479.44,80,,383.55,percent of total billed charges,80% of total billed charges,223.36,37.27,,178.69,percent of total billed charges,37.27% of total billed charges,223.36,37.27,,178.69,percent of total billed charges,37.27% of total billed charges,223.36,37.27,,178.69,percent of total billed charges,37.27% 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,239.72,40,,191.78,percent of total billed charges,40% of total billed charges,223.36,479.44,
SEREVENT DISKUS,6400014,CDM,250,RC,,,Outpatient,,,410,328.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328,80,,262.4,percent of total billed charges,80% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% 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,164,40,,131.2,percent of total billed charges,40% of total billed charges,152.81,328,
MURO-128 5% OPHT,6400014,CDM,250,RC,,,Outpatient,,,65.4,52.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.32,80,,41.86,percent of total billed charges,80% of total billed charges,24.37,37.27,,19.5,percent of total billed charges,37.27% of total billed charges,24.37,37.27,,19.5,percent of total billed charges,37.27% of total billed charges,24.37,37.27,,19.5,percent of total billed charges,37.27% 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,26.16,40,,20.93,percent of total billed charges,40% of total billed charges,24.37,52.32,
D5W 1000ML/KCL 40MEQ,5753355,CDM,258,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
DANTRIUM 25MG CAP,6400014,CDM,250,RC,,,Outpatient,,,4.3,3.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.44,80,,2.75,percent of total billed charges,80% of total billed charges,1.6,37.27,,1.28,percent of total billed charges,37.27% of total billed charges,1.6,37.27,,1.28,percent of total billed charges,37.27% of total billed charges,1.6,37.27,,1.28,percent of total billed charges,37.27% 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,1.72,40,,1.38,percent of total billed charges,40% of total billed charges,1.6,3.44,
DAYPRO 600MG CAP UD,6400014,CDM,250,RC,,,Outpatient,,,5.15,4.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.12,80,,3.3,percent of total billed charges,80% of total billed charges,1.92,37.27,,1.54,percent of total billed charges,37.27% of total billed charges,1.92,37.27,,1.54,percent of total billed charges,37.27% of total billed charges,1.92,37.27,,1.54,percent of total billed charges,37.27% 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,2.06,40,,1.65,percent of total billed charges,40% of total billed charges,1.92,4.12,
DELIVER 8 OZ,6400014,CDM,250,RC,,,Outpatient,,,7.9,6.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.32,80,,5.06,percent of total billed charges,80% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% 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,3.16,40,,2.53,percent of total billed charges,40% of total billed charges,2.94,6.32,
DEMADEX 20MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,2.85,2.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,80,,1.82,percent of total billed charges,80% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% 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,1.14,40,,0.91,percent of total billed charges,40% of total billed charges,1.06,2.28,
DEPAKOTE 125MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,3.85,3.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.08,80,,2.46,percent of total billed charges,80% of total billed charges,1.43,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.43,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.43,37.27,,1.14,percent of total billed charges,37.27% 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,1.54,40,,1.23,percent of total billed charges,40% of total billed charges,1.43,3.08,
DEPAKOTE 250MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,8.45,6.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.76,80,,5.41,percent of total billed charges,80% of total billed charges,3.15,37.27,,2.52,percent of total billed charges,37.27% of total billed charges,3.15,37.27,,2.52,percent of total billed charges,37.27% of total billed charges,3.15,37.27,,2.52,percent of total billed charges,37.27% 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,3.38,40,,2.7,percent of total billed charges,40% of total billed charges,3.15,6.76,
DESOXIMETASONE 0.05%,6400014,CDM,250,RC,,,Outpatient,,,37.95,30.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.36,80,,24.29,percent of total billed charges,80% of total billed charges,14.14,37.27,,11.31,percent of total billed charges,37.27% of total billed charges,14.14,37.27,,11.31,percent of total billed charges,37.27% of total billed charges,14.14,37.27,,11.31,percent of total billed charges,37.27% 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,15.18,40,,12.14,percent of total billed charges,40% of total billed charges,14.14,30.36,
GLUCOTROL XL 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.45,1.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.96,80,,1.57,percent of total billed charges,80% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% 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,0.98,40,,0.78,percent of total billed charges,40% of total billed charges,0.91,1.96,
ZIAC 5MG,6400014,CDM,250,RC,,,Outpatient,,,12.15,9.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.72,80,,7.78,percent of total billed charges,80% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% 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,4.86,40,,3.89,percent of total billed charges,40% of total billed charges,4.53,9.72,
IXAZEOAM 10MG,6400014,CDM,250,RC,,,Outpatient,,,3.05,2.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.44,80,,1.95,percent of total billed charges,80% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% 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,1.22,40,,0.98,percent of total billed charges,40% of total billed charges,1.14,2.44,
ATENOLOL/CHLTH 50/25,6400014,CDM,250,RC,,,Outpatient,,,5.1,4.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.08,80,,3.26,percent of total billed charges,80% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% 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,2.04,40,,1.63,percent of total billed charges,40% of total billed charges,1.9,4.08,
HYTRIN 5MG TALBET U/,6400014,CDM,250,RC,,,Outpatient,,,4.32,3.46,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.46,80,,2.77,percent of total billed charges,80% of total billed charges,1.61,37.27,,1.29,percent of total billed charges,37.27% of total billed charges,1.61,37.27,,1.29,percent of total billed charges,37.27% of total billed charges,1.61,37.27,,1.29,percent of total billed charges,37.27% 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,1.73,40,,1.38,percent of total billed charges,40% of total billed charges,1.61,3.46,
D51/2NS 1000ML/KCL 4,5753355,CDM,258,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
NS 1000ML/KCL 20MEQ,5753355,CDM,258,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
NAMENDA 5MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,30.3,24.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.24,80,,19.39,percent of total billed charges,80% of total billed charges,11.29,37.27,,9.03,percent of total billed charges,37.27% of total billed charges,11.29,37.27,,9.03,percent of total billed charges,37.27% of total billed charges,11.29,37.27,,9.03,percent of total billed charges,37.27% 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,12.12,40,,9.7,percent of total billed charges,40% of total billed charges,11.29,24.24,
D5NS 1000ML/ KCL 20M,5753355,CDM,258,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
DEXFERRUM IJ PER50MG,6065130,CDM,636,RC,J1750,HCPCS,Outpatient,,,76.73,61.38,JG,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.38,80,,49.1,percent of total billed charges,80% of total billed charges,28.6,37.27,,22.88,percent of total billed charges,37.27% of total billed charges,28.6,37.27,,22.88,percent of total billed charges,37.27% of total billed charges,28.6,37.27,,22.88,percent of total billed charges,37.27% of total billed charges,17.67,100,,,fee schedule,100% of APC rate,17.67,100,,,fee schedule,100% of APC rate,17.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,17.67,100,,,fee schedule,100% of APC rate,17.67,100,,,fee schedule,100% of APC rate,17.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.69,40,,24.55,percent of total billed charges,40% of total billed charges,17.67,61.38,
DICLOFENAC 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.97,2.38,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.38,80,,1.9,percent of total billed charges,80% of total billed charges,1.11,37.27,,0.89,percent of total billed charges,37.27% of total billed charges,1.11,37.27,,0.89,percent of total billed charges,37.27% of total billed charges,1.11,37.27,,0.89,percent of total billed charges,37.27% 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,1.19,40,,0.95,percent of total billed charges,40% of total billed charges,1.11,2.38,
DICLOFENAC 75MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.9,3.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.12,80,,2.5,percent of total billed charges,80% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% 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,1.56,40,,1.25,percent of total billed charges,40% of total billed charges,1.45,3.12,
DILEX-G LIQUID (5ML),6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
DIFLUCAN 150MG TAB,6400014,CDM,250,RC,,,Outpatient,,,59.15,47.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.32,80,,37.86,percent of total billed charges,80% of total billed charges,22.05,37.27,,17.64,percent of total billed charges,37.27% of total billed charges,22.05,37.27,,17.64,percent of total billed charges,37.27% of total billed charges,22.05,37.27,,17.64,percent of total billed charges,37.27% 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,23.66,40,,18.93,percent of total billed charges,40% of total billed charges,22.05,47.32,
DIFLUCAN 10MG/ML SUS,6400014,CDM,250,RC,,,Outpatient,,,141.1,112.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.88,80,,90.3,percent of total billed charges,80% of total billed charges,52.59,37.27,,42.07,percent of total billed charges,37.27% of total billed charges,52.59,37.27,,42.07,percent of total billed charges,37.27% of total billed charges,52.59,37.27,,42.07,percent of total billed charges,37.27% 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,56.44,40,,45.15,percent of total billed charges,40% of total billed charges,52.59,112.88,
DIFLUCAN 100MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,28.35,22.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,80,,18.14,percent of total billed charges,80% of total billed charges,10.57,37.27,,8.46,percent of total billed charges,37.27% of total billed charges,10.57,37.27,,8.46,percent of total billed charges,37.27% of total billed charges,10.57,37.27,,8.46,percent of total billed charges,37.27% 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,11.34,40,,9.07,percent of total billed charges,40% of total billed charges,10.57,22.68,
DIFLUCAN BAG 200MG/1,6065130,CDM,636,RC,J1450,HCPCS,Outpatient,,,420.55,336.44,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336.44,80,,269.15,percent of total billed charges,80% of total billed charges,156.74,37.27,,125.39,percent of total billed charges,37.27% of total billed charges,156.74,37.27,,125.39,percent of total billed charges,37.27% of total billed charges,156.74,37.27,,125.39,percent of total billed charges,37.27% 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,168.22,40,,134.58,percent of total billed charges,40% of total billed charges,156.74,336.44,
DIFLUCAN 400MG/200ML,6065130,CDM,636,RC,J1450,HCPCS,Outpatient,,,614.65,491.72,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,491.72,80,,393.38,percent of total billed charges,80% of total billed charges,229.08,37.27,,183.26,percent of total billed charges,37.27% of total billed charges,229.08,37.27,,183.26,percent of total billed charges,37.27% of total billed charges,229.08,37.27,,183.26,percent of total billed charges,37.27% 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,245.86,40,,196.69,percent of total billed charges,40% of total billed charges,229.08,491.72,
DIHISTINE EXPECTORAN,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
DILTIAZEM 30MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
DIOVAN 80MG CAP UD,6400014,CDM,250,RC,,,Outpatient,,,3.99,3.19,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.19,80,,2.55,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.19,
DIPHENHIST W/ZINC CR,6400014,CDM,250,RC,,,Outpatient,,,11.25,9.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9,80,,7.2,percent of total billed charges,80% of total billed charges,4.19,37.27,,3.35,percent of total billed charges,37.27% of total billed charges,4.19,37.27,,3.35,percent of total billed charges,37.27% of total billed charges,4.19,37.27,,3.35,percent of total billed charges,37.27% 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,4.5,40,,3.6,percent of total billed charges,40% of total billed charges,4.19,9,
AUGMENTIN SUSP 400MG,6400014,CDM,250,RC,,,Outpatient,,,194.54,155.63,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.63,80,,124.5,percent of total billed charges,80% of total billed charges,72.51,37.27,,58.01,percent of total billed charges,37.27% of total billed charges,72.51,37.27,,58.01,percent of total billed charges,37.27% of total billed charges,72.51,37.27,,58.01,percent of total billed charges,37.27% 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,77.82,40,,62.26,percent of total billed charges,40% of total billed charges,72.51,155.63,
DIPHENHYDRAMINE 50MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
DISALCID 500MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
DOCUSATE SOD 60MG/15,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
DOMEBORO PACKET,6400014,CDM,250,RC,,,Outpatient,,,2.7,2.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,80,,1.73,percent of total billed charges,80% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% 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,1.08,40,,0.86,percent of total billed charges,40% of total billed charges,1.01,2.16,
DYAZIDE 37.5/25 CAP,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
DYNACIRC 5MG CAP,6400014,CDM,250,RC,,,Outpatient,,,8.05,6.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.44,80,,5.15,percent of total billed charges,80% of total billed charges,3,37.27,,2.4,percent of total billed charges,37.27% of total billed charges,3,37.27,,2.4,percent of total billed charges,37.27% of total billed charges,3,37.27,,2.4,percent of total billed charges,37.27% 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,3.22,40,,2.58,percent of total billed charges,40% of total billed charges,3,6.44,
DYNACIRC CR 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,6.23,4.98,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.98,80,,3.98,percent of total billed charges,80% of total billed charges,2.32,37.27,,1.86,percent of total billed charges,37.27% of total billed charges,2.32,37.27,,1.86,percent of total billed charges,37.27% of total billed charges,2.32,37.27,,1.86,percent of total billed charges,37.27% 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,2.49,40,,1.99,percent of total billed charges,40% of total billed charges,2.32,4.98,
DYPHYLLINE GG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
EFFEXOR 25MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,13.25,10.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.6,80,,8.48,percent of total billed charges,80% of total billed charges,4.94,37.27,,3.95,percent of total billed charges,37.27% of total billed charges,4.94,37.27,,3.95,percent of total billed charges,37.27% of total billed charges,4.94,37.27,,3.95,percent of total billed charges,37.27% 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,5.3,40,,4.24,percent of total billed charges,40% of total billed charges,4.94,10.6,
EMLA CREAM W/TEGADER,5880901,CDM,637,RC,,,Outpatient,,,27.06,21.65,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.65,80,,17.32,percent of total billed charges,80% of total billed charges,10.09,37.27,,8.07,percent of total billed charges,37.27% of total billed charges,10.09,37.27,,8.07,percent of total billed charges,37.27% of total billed charges,10.09,37.27,,8.07,percent of total billed charges,37.27% 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,10.82,40,,8.66,percent of total billed charges,40% of total billed charges,10.09,21.65,
E-MYCIN 250MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ERYTHROMYCIN 250MG C,6400014,CDM,250,RC,,,Outpatient,,,16.15,12.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.92,80,,10.34,percent of total billed charges,80% of total billed charges,6.02,37.27,,4.82,percent of total billed charges,37.27% of total billed charges,6.02,37.27,,4.82,percent of total billed charges,37.27% of total billed charges,6.02,37.27,,4.82,percent of total billed charges,37.27% 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,6.46,40,,5.17,percent of total billed charges,40% of total billed charges,6.02,12.92,
ERYTHROMYCIN/SULFISO,5880901,CDM,637,RC,,,Outpatient,,,85.45,68.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.36,80,,54.69,percent of total billed charges,80% of total billed charges,31.85,37.27,,25.48,percent of total billed charges,37.27% of total billed charges,31.85,37.27,,25.48,percent of total billed charges,37.27% of total billed charges,31.85,37.27,,25.48,percent of total billed charges,37.27% 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,34.18,40,,27.34,percent of total billed charges,40% of total billed charges,31.85,68.36,
ERYTHROCIN LACT 500M,6065130,CDM,636,RC,J1364,HCPCS,Outpatient,,,371.9,297.52,JG,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297.52,80,,238.02,percent of total billed charges,80% of total billed charges,138.61,37.27,,110.89,percent of total billed charges,37.27% of total billed charges,138.61,37.27,,110.89,percent of total billed charges,37.27% of total billed charges,138.61,37.27,,110.89,percent of total billed charges,37.27% of total billed charges,56.57,100,,,fee schedule,100% of APC rate,56.57,100,,,fee schedule,100% of APC rate,56.57,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,56.57,100,,,fee schedule,100% of APC rate,56.57,100,,,fee schedule,100% of APC rate,56.57,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.76,40,,119.01,percent of total billed charges,40% of total billed charges,56.57,297.52,
EULEXIN 125MG CAP UD,6400014,CDM,250,RC,,,Outpatient,,,6.14,4.91,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.91,80,,3.93,percent of total billed charges,80% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% 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,2.46,40,,1.97,percent of total billed charges,40% of total billed charges,2.29,4.91,
EYE WASH SOLUTION,6400014,CDM,250,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
FELDENE 20MG CAP UD,6400014,CDM,250,RC,,,Outpatient,,,10.15,8.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.12,80,,6.5,percent of total billed charges,80% of total billed charges,3.78,37.27,,3.02,percent of total billed charges,37.27% of total billed charges,3.78,37.27,,3.02,percent of total billed charges,37.27% of total billed charges,3.78,37.27,,3.02,percent of total billed charges,37.27% 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,4.06,40,,3.25,percent of total billed charges,40% of total billed charges,3.78,8.12,
FENTANYL 0.05MG/ML A,6065130,CDM,636,RC,J3010,HCPCS,Outpatient,,,100.6,80.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.48,80,,64.38,percent of total billed charges,80% of total billed charges,37.49,37.27,,29.99,percent of total billed charges,37.27% of total billed charges,37.49,37.27,,29.99,percent of total billed charges,37.27% of total billed charges,37.49,37.27,,29.99,percent of total billed charges,37.27% 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,40.24,40,,32.19,percent of total billed charges,40% of total billed charges,37.49,80.48,
FER-GEN-SOL 75MG/0.6,6400014,CDM,250,RC,,,Outpatient,,,31.55,25.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.24,80,,20.19,percent of total billed charges,80% of total billed charges,11.76,37.27,,9.41,percent of total billed charges,37.27% of total billed charges,11.76,37.27,,9.41,percent of total billed charges,37.27% of total billed charges,11.76,37.27,,9.41,percent of total billed charges,37.27% 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,12.62,40,,10.1,percent of total billed charges,40% of total billed charges,11.76,25.24,
FERROUS GLUCONATE 32,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
FERROUS SULF 220MG/5,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
FLOVENT 44MCG INHALE,6400014,CDM,250,RC,,,Outpatient,,,169.25,135.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.4,80,,108.32,percent of total billed charges,80% of total billed charges,63.08,37.27,,50.46,percent of total billed charges,37.27% of total billed charges,63.08,37.27,,50.46,percent of total billed charges,37.27% of total billed charges,63.08,37.27,,50.46,percent of total billed charges,37.27% 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,67.7,40,,54.16,percent of total billed charges,40% of total billed charges,63.08,135.4,
FLUOCINOLONE 0.025%,6400014,CDM,250,RC,,,Outpatient,,,12.87,10.30,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.3,80,,8.24,percent of total billed charges,80% of total billed charges,4.8,37.27,,3.84,percent of total billed charges,37.27% of total billed charges,4.8,37.27,,3.84,percent of total billed charges,37.27% of total billed charges,4.8,37.27,,3.84,percent of total billed charges,37.27% 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,5.15,40,,4.12,percent of total billed charges,40% of total billed charges,4.8,10.3,
FLUOCINOLONE ACET CR,6400014,CDM,250,RC,,,Outpatient,,,9.9,7.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.92,80,,6.34,percent of total billed charges,80% of total billed charges,3.69,37.27,,2.95,percent of total billed charges,37.27% of total billed charges,3.69,37.27,,2.95,percent of total billed charges,37.27% of total billed charges,3.69,37.27,,2.95,percent of total billed charges,37.27% 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,3.96,40,,3.17,percent of total billed charges,40% of total billed charges,3.69,7.92,
FLUOCINONIDE 0.05% C,6400014,CDM,250,RC,,,Outpatient,,,132.55,106.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.04,80,,84.83,percent of total billed charges,80% of total billed charges,49.4,37.27,,39.52,percent of total billed charges,37.27% of total billed charges,49.4,37.27,,39.52,percent of total billed charges,37.27% of total billed charges,49.4,37.27,,39.52,percent of total billed charges,37.27% 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,53.02,40,,42.42,percent of total billed charges,40% of total billed charges,49.4,106.04,
FLUOR-I-STRIP,6400014,CDM,250,RC,,,Outpatient,,,2.8,2.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,80,,1.79,percent of total billed charges,80% of total billed charges,1.04,37.27,,0.83,percent of total billed charges,37.27% of total billed charges,1.04,37.27,,0.83,percent of total billed charges,37.27% of total billed charges,1.04,37.27,,0.83,percent of total billed charges,37.27% 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,1.12,40,,0.9,percent of total billed charges,40% of total billed charges,1.04,2.24,
FLUPHENAZINE 1MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
FOLIC ACID 5MG/ML VI,6400014,CDM,250,RC,,,Outpatient,,,22.9,18.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.32,80,,14.66,percent of total billed charges,80% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% of total billed charges,8.53,37.27,,6.82,percent of total billed charges,37.27% 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,9.16,40,,7.33,percent of total billed charges,40% of total billed charges,8.53,18.32,
FOSAMAX 10MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,11.45,9.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.16,80,,7.33,percent of total billed charges,80% of total billed charges,4.27,37.27,,3.42,percent of total billed charges,37.27% of total billed charges,4.27,37.27,,3.42,percent of total billed charges,37.27% of total billed charges,4.27,37.27,,3.42,percent of total billed charges,37.27% 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,4.58,40,,3.66,percent of total billed charges,40% of total billed charges,4.27,9.16,
GEMFIBROZIL 600MG TA,6400014,CDM,250,RC,,,Outpatient,,,7.85,6.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.28,80,,5.02,percent of total billed charges,80% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% 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,3.14,40,,2.51,percent of total billed charges,40% of total billed charges,2.93,6.28,
GENASYME 80MG TAB CH,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
GENATON LIQUID,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
GERI-VITE LIQUID,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
GLIPIZIDE 5MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
GLYBURIDE 2.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
GLYCOPYRROLATE 0.2MG,6065130,CDM,636,RC,J1596,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
GUIATUSS AC SYRUP,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
GUAIFENESIN ER 600MG,6400014,CDM,250,RC,,,Outpatient,,,3.8,3.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.04,80,,2.43,percent of total billed charges,80% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% 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,1.52,40,,1.22,percent of total billed charges,40% of total billed charges,1.42,3.04,
HALOPERIDOL 0.5MG TA,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
HALOPERIDOL 1MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
HALOPERIDOL 2MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.85,2.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,80,,1.82,percent of total billed charges,80% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% 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,1.14,40,,0.91,percent of total billed charges,40% of total billed charges,1.06,2.28,
HALOPERIDOL 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.7,2.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.96,80,,2.37,percent of total billed charges,80% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% 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,1.48,40,,1.18,percent of total billed charges,40% of total billed charges,1.38,2.96,
HALOPERIDOL CONC 2MG,6065130,CDM,636,RC,J1630,HCPCS,Outpatient,,,45.43,36.34,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.34,80,,29.07,percent of total billed charges,80% of total billed charges,16.93,37.27,,13.54,percent of total billed charges,37.27% of total billed charges,16.93,37.27,,13.54,percent of total billed charges,37.27% of total billed charges,16.93,37.27,,13.54,percent of total billed charges,37.27% 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,18.17,40,,14.54,percent of total billed charges,40% of total billed charges,16.93,36.34,
HALOPERIDOL LAC 5MG/,6065130,CDM,636,RC,J1630,HCPCS,Outpatient,,,24.7,19.76,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.76,80,,15.81,percent of total billed charges,80% of total billed charges,9.21,37.27,,7.37,percent of total billed charges,37.27% of total billed charges,9.21,37.27,,7.37,percent of total billed charges,37.27% of total billed charges,9.21,37.27,,7.37,percent of total billed charges,37.27% 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,9.88,40,,7.9,percent of total billed charges,40% of total billed charges,9.21,19.76,
HETASTARCH 6%/NS 500,6400014,CDM,250,RC,,,Outpatient,,,249,199.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.2,80,,159.36,percent of total billed charges,80% of total billed charges,92.8,37.27,,74.24,percent of total billed charges,37.27% of total billed charges,92.8,37.27,,74.24,percent of total billed charges,37.27% of total billed charges,92.8,37.27,,74.24,percent of total billed charges,37.27% 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,99.6,40,,79.68,percent of total billed charges,40% of total billed charges,92.8,199.2,
HYDRALAZINE 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
HYDRALAZINE 20MG/ML,6065130,CDM,636,RC,J0360,HCPCS,Outpatient,,,180.95,144.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.76,80,,115.81,percent of total billed charges,80% of total billed charges,67.44,37.27,,53.95,percent of total billed charges,37.27% of total billed charges,67.44,37.27,,53.95,percent of total billed charges,37.27% of total billed charges,67.44,37.27,,53.95,percent of total billed charges,37.27% 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,72.38,40,,57.9,percent of total billed charges,40% of total billed charges,67.44,144.76,
HYDRALAZINE 25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.1,1.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,80,,1.34,percent of total billed charges,80% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% 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,0.84,40,,0.67,percent of total billed charges,40% of total billed charges,0.78,1.68,
HYDRAMINE 12.5MG/5ML,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
HYDROXYZINE HCL 50MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
HYOSCYAMINE DROPS 0.,6400014,CDM,250,RC,,,Outpatient,,,136.35,109.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.08,80,,87.26,percent of total billed charges,80% of total billed charges,50.82,37.27,,40.66,percent of total billed charges,37.27% of total billed charges,50.82,37.27,,40.66,percent of total billed charges,37.27% of total billed charges,50.82,37.27,,40.66,percent of total billed charges,37.27% 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,54.54,40,,43.63,percent of total billed charges,40% of total billed charges,50.82,109.08,
HYOSCYAMINE 0.375MG,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
HYOSCYAMINE 0.375MG,6400014,CDM,250,RC,,,Outpatient,,,5.45,4.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.36,80,,3.49,percent of total billed charges,80% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% 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,2.18,40,,1.74,percent of total billed charges,40% of total billed charges,2.03,4.36,
HYOSCYAMINE 125MCG/5,6400014,CDM,250,RC,,,Outpatient,,,23.3,18.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.64,80,,14.91,percent of total billed charges,80% of total billed charges,8.68,37.27,,6.94,percent of total billed charges,37.27% of total billed charges,8.68,37.27,,6.94,percent of total billed charges,37.27% of total billed charges,8.68,37.27,,6.94,percent of total billed charges,37.27% 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,9.32,40,,7.46,percent of total billed charges,40% of total billed charges,8.68,18.64,
HYOSOL/SL 0.125MG TA,6400014,CDM,250,RC,,,Outpatient,,,3.7,2.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.96,80,,2.37,percent of total billed charges,80% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% 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,1.48,40,,1.18,percent of total billed charges,40% of total billed charges,1.38,2.96,
HYOSOPHEN TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
HYTRIN 1MG CAP UD,6400014,CDM,250,RC,,,Outpatient,,,5.45,4.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.36,80,,3.49,percent of total billed charges,80% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% 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,2.18,40,,1.74,percent of total billed charges,40% of total billed charges,2.03,4.36,
IBUPROFEN 400MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
IBUPROFEN 600MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
IBUPROFEN 800MG TABL,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
INDERAL LA 160MG CAP,6400014,CDM,250,RC,,,Outpatient,,,5.74,4.59,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.59,80,,3.67,percent of total billed charges,80% of total billed charges,2.14,37.27,,1.71,percent of total billed charges,37.27% of total billed charges,2.14,37.27,,1.71,percent of total billed charges,37.27% of total billed charges,2.14,37.27,,1.71,percent of total billed charges,37.27% 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,2.3,40,,1.84,percent of total billed charges,40% of total billed charges,2.14,4.59,
INDERAL LA 60MG CAPS,6400014,CDM,250,RC,,,Outpatient,,,6.95,5.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.56,80,,4.45,percent of total billed charges,80% of total billed charges,2.59,37.27,,2.07,percent of total billed charges,37.27% of total billed charges,2.59,37.27,,2.07,percent of total billed charges,37.27% of total billed charges,2.59,37.27,,2.07,percent of total billed charges,37.27% 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,2.78,40,,2.22,percent of total billed charges,40% of total billed charges,2.59,5.56,
INDOMETHACIN 75MG CA,6400014,CDM,250,RC,,,Outpatient,,,10.25,8.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.2,80,,6.56,percent of total billed charges,80% of total billed charges,3.82,37.27,,3.06,percent of total billed charges,37.27% of total billed charges,3.82,37.27,,3.06,percent of total billed charges,37.27% of total billed charges,3.82,37.27,,3.06,percent of total billed charges,37.27% 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,4.1,40,,3.28,percent of total billed charges,40% of total billed charges,3.82,8.2,
IODAL HD SYRUP,6400014,CDM,250,RC,,,Outpatient,,,3.65,2.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.92,80,,2.34,percent of total billed charges,80% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% 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,1.46,40,,1.17,percent of total billed charges,40% of total billed charges,1.36,2.92,
IPRATROPIUM BR 0.02%,5880901,CDM,637,RC,,,Outpatient,,,6,4.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
ISONIAZID 300MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ISOSORBIDE DN 10MG T,6400014,CDM,250,RC,,,Outpatient,,,3.7,2.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.96,80,,2.37,percent of total billed charges,80% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% 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,1.48,40,,1.18,percent of total billed charges,40% of total billed charges,1.38,2.96,
ISOSORBIDE DN 10MG T,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
ISOSORBIDE DN 40MG T,6400014,CDM,250,RC,,,Outpatient,,,8.1,6.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.48,80,,5.18,percent of total billed charges,80% of total billed charges,3.02,37.27,,2.42,percent of total billed charges,37.27% of total billed charges,3.02,37.27,,2.42,percent of total billed charges,37.27% of total billed charges,3.02,37.27,,2.42,percent of total billed charges,37.27% 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,3.24,40,,2.59,percent of total billed charges,40% of total billed charges,3.02,6.48,
KCL 10% LIQUID (20ME,6400014,CDM,250,RC,,,Outpatient,,,11.35,9.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.08,80,,7.26,percent of total billed charges,80% of total billed charges,4.23,37.27,,3.38,percent of total billed charges,37.27% of total billed charges,4.23,37.27,,3.38,percent of total billed charges,37.27% of total billed charges,4.23,37.27,,3.38,percent of total billed charges,37.27% 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,4.54,40,,3.63,percent of total billed charges,40% of total billed charges,4.23,9.08,
KETOROLAC 15MG/ML VI,6065130,CDM,636,RC,J1885,HCPCS,Outpatient,,,30.6,24.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.48,80,,19.58,percent of total billed charges,80% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% 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,12.24,40,,9.79,percent of total billed charges,40% of total billed charges,11.4,24.48,
KETOROLAC 30MG/ML VI,6065130,CDM,636,RC,J1885,HCPCS,Outpatient,,,30.6,24.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.48,80,,19.58,percent of total billed charges,80% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% 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,12.24,40,,9.79,percent of total billed charges,40% of total billed charges,11.4,24.48,
KETOROLAC 60MG/2ML V,6065130,CDM,636,RC,J1885,HCPCS,Outpatient,,,31.74,25.39,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.39,80,,20.31,percent of total billed charges,80% of total billed charges,11.83,37.27,,9.46,percent of total billed charges,37.27% of total billed charges,11.83,37.27,,9.46,percent of total billed charges,37.27% of total billed charges,11.83,37.27,,9.46,percent of total billed charges,37.27% 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,12.7,40,,10.16,percent of total billed charges,40% of total billed charges,11.83,25.39,
KLOR-CON/EF 25MEQ TA,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
LEVAQUIN 250MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,33,26.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% 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,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,12.3,26.4,
LEVOTHROID 75MCG TAB,6400014,CDM,250,RC,,,Outpatient,,,6.45,5.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.16,80,,4.13,percent of total billed charges,80% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% 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,2.58,40,,2.06,percent of total billed charges,40% of total billed charges,2.4,5.16,
LEVOXYL 25MCG TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
LEVOXYL 75MCG TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
LIDOCAINE 2%/EPI 1:2,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,41.4,33.12,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.12,80,,26.5,percent of total billed charges,80% of total billed charges,15.43,37.27,,12.34,percent of total billed charges,37.27% of total billed charges,15.43,37.27,,12.34,percent of total billed charges,37.27% of total billed charges,15.43,37.27,,12.34,percent of total billed charges,37.27% 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,16.56,40,,13.25,percent of total billed charges,40% of total billed charges,15.43,33.12,
GENTAMICIN 80MG/100M,6065130,CDM,636,RC,J1580,HCPCS,Outpatient,,,81.15,64.92,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.92,80,,51.94,percent of total billed charges,80% of total billed charges,30.24,37.27,,24.19,percent of total billed charges,37.27% of total billed charges,30.24,37.27,,24.19,percent of total billed charges,37.27% of total billed charges,30.24,37.27,,24.19,percent of total billed charges,37.27% 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,32.46,40,,25.97,percent of total billed charges,40% of total billed charges,30.24,64.92,
PRAVACHOL 40MG TABLE,6400014,CDM,250,RC,,,Outpatient,,,11.72,9.38,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.38,80,,7.5,percent of total billed charges,80% of total billed charges,4.37,37.27,,3.5,percent of total billed charges,37.27% of total billed charges,4.37,37.27,,3.5,percent of total billed charges,37.27% of total billed charges,4.37,37.27,,3.5,percent of total billed charges,37.27% 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,4.69,40,,3.75,percent of total billed charges,40% of total billed charges,4.37,9.38,
PENICILLIN G POT 1MM,6065130,CDM,636,RC,J2540,HCPCS,Outpatient,,,208.2,166.56,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.56,80,,133.25,percent of total billed charges,80% of total billed charges,77.6,37.27,,62.08,percent of total billed charges,37.27% of total billed charges,77.6,37.27,,62.08,percent of total billed charges,37.27% of total billed charges,77.6,37.27,,62.08,percent of total billed charges,37.27% 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,83.28,40,,66.62,percent of total billed charges,40% of total billed charges,77.6,166.56,
PEPCID 10MG/ML VIAL,6400014,CDM,250,RC,,,Outpatient,,,53.8,43.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.04,80,,34.43,percent of total billed charges,80% of total billed charges,20.05,37.27,,16.04,percent of total billed charges,37.27% of total billed charges,20.05,37.27,,16.04,percent of total billed charges,37.27% of total billed charges,20.05,37.27,,16.04,percent of total billed charges,37.27% 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,21.52,40,,17.22,percent of total billed charges,40% of total billed charges,20.05,43.04,
PANCREASE MT 20 CAPS,6400014,CDM,250,RC,,,Outpatient,,,6.5,5.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.2,80,,4.16,percent of total billed charges,80% of total billed charges,2.42,37.27,,1.94,percent of total billed charges,37.27% of total billed charges,2.42,37.27,,1.94,percent of total billed charges,37.27% of total billed charges,2.42,37.27,,1.94,percent of total billed charges,37.27% 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,2.6,40,,2.08,percent of total billed charges,40% of total billed charges,2.42,5.2,
NORVASC 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,4.15,3.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.32,80,,2.66,percent of total billed charges,80% of total billed charges,1.55,37.27,,1.24,percent of total billed charges,37.27% of total billed charges,1.55,37.27,,1.24,percent of total billed charges,37.27% of total billed charges,1.55,37.27,,1.24,percent of total billed charges,37.27% 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,1.66,40,,1.33,percent of total billed charges,40% of total billed charges,1.55,3.32,
LUBRIDERM LOTION,6400014,CDM,250,RC,,,Outpatient,,,17.42,13.94,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.94,80,,11.15,percent of total billed charges,80% of total billed charges,6.49,37.27,,5.19,percent of total billed charges,37.27% of total billed charges,6.49,37.27,,5.19,percent of total billed charges,37.27% of total billed charges,6.49,37.27,,5.19,percent of total billed charges,37.27% 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,6.97,40,,5.58,percent of total billed charges,40% of total billed charges,6.49,13.94,
NICODERM PATCH (14 M,6400014,CDM,250,RC,,,Outpatient,,,8.65,6.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.92,80,,5.54,percent of total billed charges,80% of total billed charges,3.22,37.27,,2.58,percent of total billed charges,37.27% of total billed charges,3.22,37.27,,2.58,percent of total billed charges,37.27% of total billed charges,3.22,37.27,,2.58,percent of total billed charges,37.27% 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,3.46,40,,2.77,percent of total billed charges,40% of total billed charges,3.22,6.92,
CARDIZEM CD 180MG CA,6400014,CDM,250,RC,,,Outpatient,,,5.15,4.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.12,80,,3.3,percent of total billed charges,80% of total billed charges,1.92,37.27,,1.54,percent of total billed charges,37.27% of total billed charges,1.92,37.27,,1.54,percent of total billed charges,37.27% of total billed charges,1.92,37.27,,1.54,percent of total billed charges,37.27% 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,2.06,40,,1.65,percent of total billed charges,40% of total billed charges,1.92,4.12,
DOCUSATE CALCIUM 240,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
SENOKOT-S TAB U/D,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CARBIDOPA/LERODOPA 1,6400014,CDM,250,RC,,,Outpatient,,,4.1,3.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.28,80,,2.62,percent of total billed charges,80% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% 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,1.64,40,,1.31,percent of total billed charges,40% of total billed charges,1.53,3.28,
ZESTRIL 5MG TAB U/D,6400014,CDM,250,RC,,,Outpatient,,,3.3,2.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.64,80,,2.11,percent of total billed charges,80% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% 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,1.32,40,,1.06,percent of total billed charges,40% of total billed charges,1.23,2.64,
CIPRO 500MG TAB U/D,6400014,CDM,250,RC,,,Outpatient,,,23.45,18.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.76,80,,15.01,percent of total billed charges,80% of total billed charges,8.74,37.27,,6.99,percent of total billed charges,37.27% of total billed charges,8.74,37.27,,6.99,percent of total billed charges,37.27% of total billed charges,8.74,37.27,,6.99,percent of total billed charges,37.27% 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,9.38,40,,7.5,percent of total billed charges,40% of total billed charges,8.74,18.76,
TRIAZOLAM .125MG TAB,6400014,CDM,250,RC,,,Outpatient,,,12.9,10.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.32,80,,8.26,percent of total billed charges,80% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% 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,5.16,40,,4.13,percent of total billed charges,40% of total billed charges,4.81,10.32,
TIGAN 200MG,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
SLO-NIACIN 500,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PARNATE 10MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,2.65,2.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.12,80,,1.7,percent of total billed charges,80% of total billed charges,0.99,37.27,,0.79,percent of total billed charges,37.27% of total billed charges,0.99,37.27,,0.79,percent of total billed charges,37.27% of total billed charges,0.99,37.27,,0.79,percent of total billed charges,37.27% 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,1.06,40,,0.85,percent of total billed charges,40% of total billed charges,0.99,2.12,
UNIVASC 7.5MG (MOEXI,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
NS 1000ML,5753355,CDM,258,RC,J7030,HCPCS,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
DISTILLED WATER 1000,5645742,CDM,270,RC,,,Outpatient,,,1.33,1.06,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.06,80,,0.85,percent of total billed charges,80% of total billed charges,0.5,37.27,,0.4,percent of total billed charges,37.27% of total billed charges,0.5,37.27,,0.4,percent of total billed charges,37.27% of total billed charges,0.5,37.27,,0.4,percent of total billed charges,37.27% 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,0.53,40,,0.42,percent of total billed charges,40% of total billed charges,0.5,1.06,
SANDOSTATIN AMP,6065130,CDM,636,RC,J2354,HCPCS,Outpatient,,,86.6,69.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.28,80,,55.42,percent of total billed charges,80% of total billed charges,32.28,37.27,,25.82,percent of total billed charges,37.27% of total billed charges,32.28,37.27,,25.82,percent of total billed charges,37.27% of total billed charges,32.28,37.27,,25.82,percent of total billed charges,37.27% 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,34.64,40,,27.71,percent of total billed charges,40% of total billed charges,32.28,69.28,
PENTASA CAP 250MG,6400014,CDM,250,RC,,,Outpatient,,,12.4,9.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.92,80,,7.94,percent of total billed charges,80% of total billed charges,4.62,37.27,,3.7,percent of total billed charges,37.27% of total billed charges,4.62,37.27,,3.7,percent of total billed charges,37.27% of total billed charges,4.62,37.27,,3.7,percent of total billed charges,37.27% 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,4.96,40,,3.97,percent of total billed charges,40% of total billed charges,4.62,9.92,
ACTIVASE 100 MG VIAL,6065130,CDM,636,RC,J2997,HCPCS,Outpatient,,,24289,19431.20,JG,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19431.2,80,,15544.96,percent of total billed charges,80% of total billed charges,9052.51,37.27,,7242.01,percent of total billed charges,37.27% of total billed charges,9052.51,37.27,,7242.01,percent of total billed charges,37.27% of total billed charges,9052.51,37.27,,7242.01,percent of total billed charges,37.27% of total billed charges,91.47,100,,,fee schedule,100% of APC rate,91.47,100,,,fee schedule,100% of APC rate,91.47,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,91.47,100,,,fee schedule,100% of APC rate,91.47,100,,,fee schedule,100% of APC rate,91.47,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9715.6,40,,7772.48,percent of total billed charges,40% of total billed charges,91.47,19431.2,
REMERON 15MG,6400014,CDM,250,RC,,,Outpatient,,,9.7,7.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.76,80,,6.21,percent of total billed charges,80% of total billed charges,3.62,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.62,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.62,37.27,,2.9,percent of total billed charges,37.27% 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,3.88,40,,3.1,percent of total billed charges,40% of total billed charges,3.62,7.76,
FAMVIR 250MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,26.3,21.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.04,80,,16.83,percent of total billed charges,80% of total billed charges,9.8,37.27,,7.84,percent of total billed charges,37.27% of total billed charges,9.8,37.27,,7.84,percent of total billed charges,37.27% of total billed charges,9.8,37.27,,7.84,percent of total billed charges,37.27% 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,10.52,40,,8.42,percent of total billed charges,40% of total billed charges,9.8,21.04,
CLARITIN-D,6400014,CDM,250,RC,,,Outpatient,,,3.54,2.83,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.83,80,,2.26,percent of total billed charges,80% of total billed charges,1.32,37.27,,1.06,percent of total billed charges,37.27% of total billed charges,1.32,37.27,,1.06,percent of total billed charges,37.27% of total billed charges,1.32,37.27,,1.06,percent of total billed charges,37.27% 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,1.42,40,,1.14,percent of total billed charges,40% of total billed charges,1.32,2.83,
ASACOL 400MG (MESALA,6400014,CDM,250,RC,,,Outpatient,,,9.9,7.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.92,80,,6.34,percent of total billed charges,80% of total billed charges,3.69,37.27,,2.95,percent of total billed charges,37.27% of total billed charges,3.69,37.27,,2.95,percent of total billed charges,37.27% of total billed charges,3.69,37.27,,2.95,percent of total billed charges,37.27% 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,3.96,40,,3.17,percent of total billed charges,40% of total billed charges,3.69,7.92,
BACTROBAN NASAL OINT,6400014,CDM,250,RC,,,Outpatient,,,16.8,13.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,80,,10.75,percent of total billed charges,80% of total billed charges,6.26,37.27,,5.01,percent of total billed charges,37.27% of total billed charges,6.26,37.27,,5.01,percent of total billed charges,37.27% of total billed charges,6.26,37.27,,5.01,percent of total billed charges,37.27% 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,6.72,40,,5.38,percent of total billed charges,40% of total billed charges,6.26,13.44,
LEVSIN INJ,6065130,CDM,636,RC,J1980,HCPCS,Outpatient,,,233.55,186.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186.84,80,,149.47,percent of total billed charges,80% of total billed charges,87.04,37.27,,69.63,percent of total billed charges,37.27% of total billed charges,87.04,37.27,,69.63,percent of total billed charges,37.27% of total billed charges,87.04,37.27,,69.63,percent of total billed charges,37.27% 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,93.42,40,,74.74,percent of total billed charges,40% of total billed charges,87.04,186.84,
CARDIZEM CD 120MG,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
TYLENOL PM TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
SYNTHROID 0.075 MG,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
MACROBID 100MG CAP,6400014,CDM,250,RC,,,Outpatient,,,14.9,11.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.92,80,,9.54,percent of total billed charges,80% of total billed charges,5.55,37.27,,4.44,percent of total billed charges,37.27% of total billed charges,5.55,37.27,,4.44,percent of total billed charges,37.27% of total billed charges,5.55,37.27,,4.44,percent of total billed charges,37.27% 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,5.96,40,,4.77,percent of total billed charges,40% of total billed charges,5.55,11.92,
CLEOCIN VAG. CRM. W/,6400014,CDM,250,RC,,,Outpatient,,,702.2,561.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,561.76,80,,449.41,percent of total billed charges,80% of total billed charges,261.71,37.27,,209.37,percent of total billed charges,37.27% of total billed charges,261.71,37.27,,209.37,percent of total billed charges,37.27% of total billed charges,261.71,37.27,,209.37,percent of total billed charges,37.27% 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,280.88,40,,224.7,percent of total billed charges,40% of total billed charges,261.71,561.76,
CYANOCOBLAMIN 1000MC,6400014,CDM,250,RC,,,Outpatient,,,9.52,7.62,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.62,80,,6.1,percent of total billed charges,80% of total billed charges,3.55,37.27,,2.84,percent of total billed charges,37.27% of total billed charges,3.55,37.27,,2.84,percent of total billed charges,37.27% of total billed charges,3.55,37.27,,2.84,percent of total billed charges,37.27% 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,3.81,40,,3.05,percent of total billed charges,40% of total billed charges,3.55,7.62,
DESIPRAMINE 25MG U/D,6400014,CDM,250,RC,,,Outpatient,,,1.38,1.10,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.1,80,,0.88,percent of total billed charges,80% of total billed charges,0.51,37.27,,0.41,percent of total billed charges,37.27% of total billed charges,0.51,37.27,,0.41,percent of total billed charges,37.27% of total billed charges,0.51,37.27,,0.41,percent of total billed charges,37.27% 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,0.55,40,,0.44,percent of total billed charges,40% of total billed charges,0.51,1.1,
POLY VI FLOR W/IRON,6400014,CDM,250,RC,,,Outpatient,,,33.26,26.61,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.61,80,,21.29,percent of total billed charges,80% of total billed charges,12.4,37.27,,9.92,percent of total billed charges,37.27% of total billed charges,12.4,37.27,,9.92,percent of total billed charges,37.27% of total billed charges,12.4,37.27,,9.92,percent of total billed charges,37.27% 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,13.3,40,,10.64,percent of total billed charges,40% of total billed charges,12.4,26.61,
METROGEL-VAGINAL GEL,6400014,CDM,250,RC,,,Outpatient,,,477.3,381.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,381.84,80,,305.47,percent of total billed charges,80% of total billed charges,177.89,37.27,,142.31,percent of total billed charges,37.27% of total billed charges,177.89,37.27,,142.31,percent of total billed charges,37.27% of total billed charges,177.89,37.27,,142.31,percent of total billed charges,37.27% 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,190.92,40,,152.74,percent of total billed charges,40% of total billed charges,177.89,381.84,
DILACOR XR 180MG CAP,6400014,CDM,250,RC,,,Outpatient,,,3.24,2.59,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.59,80,,2.07,percent of total billed charges,80% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% 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,1.3,40,,1.04,percent of total billed charges,40% of total billed charges,1.21,2.59,
TRICOR 200MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,8.21,6.57,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.57,80,,5.26,percent of total billed charges,80% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% 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,3.28,40,,2.62,percent of total billed charges,40% of total billed charges,3.06,6.57,
MAG SULFATE 50% AMP,6065130,CDM,636,RC,J3475,HCPCS,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
AMINOSYN 8.5% ELECT,6400014,CDM,250,RC,,,Outpatient,,,199.8,159.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.84,80,,127.87,percent of total billed charges,80% of total billed charges,74.47,37.27,,59.58,percent of total billed charges,37.27% of total billed charges,74.47,37.27,,59.58,percent of total billed charges,37.27% of total billed charges,74.47,37.27,,59.58,percent of total billed charges,37.27% 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,79.92,40,,63.94,percent of total billed charges,40% of total billed charges,74.47,159.84,
TETANUS/DIPHTHERIA T,6065130,CDM,636,RC,90714,HCPCS,Outpatient,,,161.55,129.24,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.24,80,,103.39,percent of total billed charges,80% of total billed charges,60.21,37.27,,48.17,percent of total billed charges,37.27% of total billed charges,60.21,37.27,,48.17,percent of total billed charges,37.27% of total billed charges,60.21,37.27,,48.17,percent of total billed charges,37.27% 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,64.62,40,,51.7,percent of total billed charges,40% of total billed charges,60.21,129.24,
AFRIN NOSE DROPS,6400014,CDM,250,RC,,,Outpatient,,,4.2,3.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.36,80,,2.69,percent of total billed charges,80% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% 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,1.68,40,,1.34,percent of total billed charges,40% of total billed charges,1.57,3.36,
VOLTAREN OPHTH 0.1%,6400014,CDM,250,RC,,,Outpatient,,,58.18,46.54,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.54,80,,37.23,percent of total billed charges,80% of total billed charges,21.68,37.27,,17.34,percent of total billed charges,37.27% of total billed charges,21.68,37.27,,17.34,percent of total billed charges,37.27% of total billed charges,21.68,37.27,,17.34,percent of total billed charges,37.27% 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,23.27,40,,18.62,percent of total billed charges,40% of total billed charges,21.68,46.54,
CLARITIN 10MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,2.9,2.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.32,80,,1.86,percent of total billed charges,80% of total billed charges,1.08,37.27,,0.86,percent of total billed charges,37.27% of total billed charges,1.08,37.27,,0.86,percent of total billed charges,37.27% of total billed charges,1.08,37.27,,0.86,percent of total billed charges,37.27% 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,1.16,40,,0.93,percent of total billed charges,40% of total billed charges,1.08,2.32,
PREPIDIL GEL SYRINGE,6400014,CDM,250,RC,,,Outpatient,,,308.55,246.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.84,80,,197.47,percent of total billed charges,80% of total billed charges,115,37.27,,92,percent of total billed charges,37.27% of total billed charges,115,37.27,,92,percent of total billed charges,37.27% of total billed charges,115,37.27,,92,percent of total billed charges,37.27% 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,123.42,40,,98.74,percent of total billed charges,40% of total billed charges,115,246.84,
SOD CHL INJ .9% CARP,6400014,CDM,250,RC,,,Outpatient,,,15.8,12.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.64,80,,10.11,percent of total billed charges,80% of total billed charges,5.89,37.27,,4.71,percent of total billed charges,37.27% of total billed charges,5.89,37.27,,4.71,percent of total billed charges,37.27% of total billed charges,5.89,37.27,,4.71,percent of total billed charges,37.27% 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,6.32,40,,5.06,percent of total billed charges,40% of total billed charges,5.89,12.64,
HEMORRHOIDAL HC SUPP,6400014,CDM,250,RC,,,Outpatient,,,49.15,39.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.32,80,,31.46,percent of total billed charges,80% of total billed charges,18.32,37.27,,14.66,percent of total billed charges,37.27% of total billed charges,18.32,37.27,,14.66,percent of total billed charges,37.27% of total billed charges,18.32,37.27,,14.66,percent of total billed charges,37.27% 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,19.66,40,,15.73,percent of total billed charges,40% of total billed charges,18.32,39.32,
ZOLOFT 100MG TAB,6400014,CDM,250,RC,,,Outpatient,,,10.4,8.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.32,80,,6.66,percent of total billed charges,80% of total billed charges,3.88,37.27,,3.1,percent of total billed charges,37.27% of total billed charges,3.88,37.27,,3.1,percent of total billed charges,37.27% of total billed charges,3.88,37.27,,3.1,percent of total billed charges,37.27% 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,4.16,40,,3.33,percent of total billed charges,40% of total billed charges,3.88,8.32,
VANTIN 100MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,26.3,21.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.04,80,,16.83,percent of total billed charges,80% of total billed charges,9.8,37.27,,7.84,percent of total billed charges,37.27% of total billed charges,9.8,37.27,,7.84,percent of total billed charges,37.27% of total billed charges,9.8,37.27,,7.84,percent of total billed charges,37.27% 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,10.52,40,,8.42,percent of total billed charges,40% of total billed charges,9.8,21.04,
ORTHO-EST 1.225MG TA,6400014,CDM,250,RC,,,Outpatient,,,1.5,1.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.2,80,,0.96,percent of total billed charges,80% of total billed charges,0.56,37.27,,0.45,percent of total billed charges,37.27% of total billed charges,0.56,37.27,,0.45,percent of total billed charges,37.27% of total billed charges,0.56,37.27,,0.45,percent of total billed charges,37.27% 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,0.6,40,,0.48,percent of total billed charges,40% of total billed charges,0.56,1.2,
LAMISIL CREAM 1%,6400014,CDM,250,RC,,,Outpatient,,,71.94,57.55,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.55,80,,46.04,percent of total billed charges,80% of total billed charges,26.81,37.27,,21.45,percent of total billed charges,37.27% of total billed charges,26.81,37.27,,21.45,percent of total billed charges,37.27% of total billed charges,26.81,37.27,,21.45,percent of total billed charges,37.27% 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,28.78,40,,23.02,percent of total billed charges,40% of total billed charges,26.81,57.55,
RYTHMOL 150MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,5.55,4.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.44,80,,3.55,percent of total billed charges,80% of total billed charges,2.07,37.27,,1.66,percent of total billed charges,37.27% of total billed charges,2.07,37.27,,1.66,percent of total billed charges,37.27% of total billed charges,2.07,37.27,,1.66,percent of total billed charges,37.27% 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,2.22,40,,1.78,percent of total billed charges,40% of total billed charges,2.07,4.44,
LORTAB 2.5/500,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
ACULAR OPHTH SOLN,6400014,CDM,250,RC,,,Outpatient,,,613,490.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,490.4,80,,392.32,percent of total billed charges,80% of total billed charges,228.47,37.27,,182.78,percent of total billed charges,37.27% of total billed charges,228.47,37.27,,182.78,percent of total billed charges,37.27% of total billed charges,228.47,37.27,,182.78,percent of total billed charges,37.27% 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,245.2,40,,196.16,percent of total billed charges,40% of total billed charges,228.47,490.4,
POLY VI FLOR 1MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
OXAZEPAM 15MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.8,3.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.04,80,,2.43,percent of total billed charges,80% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% 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,1.52,40,,1.22,percent of total billed charges,40% of total billed charges,1.42,3.04,
AMBIEN 10MG TABLET U,6400014,CDM,250,RC,,,Outpatient,,,17.95,14.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.36,80,,11.49,percent of total billed charges,80% of total billed charges,6.69,37.27,,5.35,percent of total billed charges,37.27% of total billed charges,6.69,37.27,,5.35,percent of total billed charges,37.27% of total billed charges,6.69,37.27,,5.35,percent of total billed charges,37.27% 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,7.18,40,,5.74,percent of total billed charges,40% of total billed charges,6.69,14.36,
IMDUR TABLET,6400014,CDM,250,RC,,,Outpatient,,,4.6,3.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.68,80,,2.94,percent of total billed charges,80% of total billed charges,1.71,37.27,,1.37,percent of total billed charges,37.27% of total billed charges,1.71,37.27,,1.37,percent of total billed charges,37.27% of total billed charges,1.71,37.27,,1.37,percent of total billed charges,37.27% 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,1.84,40,,1.47,percent of total billed charges,40% of total billed charges,1.71,3.68,
LEVSIN/SL,6400014,CDM,250,RC,,,Outpatient,,,1.68,1.34,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.34,80,,1.07,percent of total billed charges,80% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% 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,0.67,40,,0.54,percent of total billed charges,40% of total billed charges,0.63,1.34,
ZOSYN 2.25MG,6065130,CDM,636,RC,J2543,HCPCS,Outpatient,,,34.7,27.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.76,80,,22.21,percent of total billed charges,80% of total billed charges,12.93,37.27,,10.34,percent of total billed charges,37.27% of total billed charges,12.93,37.27,,10.34,percent of total billed charges,37.27% of total billed charges,12.93,37.27,,10.34,percent of total billed charges,37.27% 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,13.88,40,,11.1,percent of total billed charges,40% of total billed charges,12.93,27.76,
POLY VI FLOR,6400014,CDM,250,RC,,,Outpatient,,,33.36,26.69,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.69,80,,21.35,percent of total billed charges,80% of total billed charges,12.43,37.27,,9.94,percent of total billed charges,37.27% of total billed charges,12.43,37.27,,9.94,percent of total billed charges,37.27% of total billed charges,12.43,37.27,,9.94,percent of total billed charges,37.27% 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,13.34,40,,10.67,percent of total billed charges,40% of total billed charges,12.43,26.69,
LORCET-10/650 TAB,6400014,CDM,250,RC,,,Outpatient,,,6.05,4.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,80,,3.87,percent of total billed charges,80% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% 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,2.42,40,,1.94,percent of total billed charges,40% of total billed charges,2.25,4.84,
PRAVACHOL 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,11.6,9.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,80,,7.42,percent of total billed charges,80% of total billed charges,4.32,37.27,,3.46,percent of total billed charges,37.27% of total billed charges,4.32,37.27,,3.46,percent of total billed charges,37.27% of total billed charges,4.32,37.27,,3.46,percent of total billed charges,37.27% 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,4.64,40,,3.71,percent of total billed charges,40% of total billed charges,4.32,9.28,
CARDNEN-SR-60MG,6400014,CDM,250,RC,,,Outpatient,,,3.86,3.09,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.09,80,,2.47,percent of total billed charges,80% of total billed charges,1.44,37.27,,1.15,percent of total billed charges,37.27% of total billed charges,1.44,37.27,,1.15,percent of total billed charges,37.27% of total billed charges,1.44,37.27,,1.15,percent of total billed charges,37.27% 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,1.54,40,,1.23,percent of total billed charges,40% of total billed charges,1.44,3.09,
CATAFLAM 50MG,6400014,CDM,250,RC,,,Outpatient,,,4.75,3.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.8,80,,3.04,percent of total billed charges,80% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% 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,1.9,40,,1.52,percent of total billed charges,40% of total billed charges,1.77,3.8,
DILOR G TABLET,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
BACITRACIN FOIL PKS,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
DIPHENHYDRAMINE 25MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
HIBICLENS CLEANER 4,5645742,CDM,270,RC,,,Outpatient,,,11.75,9.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.4,80,,7.52,percent of total billed charges,80% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% of total billed charges,4.38,37.27,,3.5,percent of total billed charges,37.27% 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,4.7,40,,3.76,percent of total billed charges,40% of total billed charges,4.38,9.4,
TOBRAMYCIN (NEBCIN),6065130,CDM,636,RC,J3260,HCPCS,Outpatient,,,37.35,29.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.88,80,,23.9,percent of total billed charges,80% of total billed charges,13.92,37.27,,11.14,percent of total billed charges,37.27% of total billed charges,13.92,37.27,,11.14,percent of total billed charges,37.27% of total billed charges,13.92,37.27,,11.14,percent of total billed charges,37.27% 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,14.94,40,,11.95,percent of total billed charges,40% of total billed charges,13.92,29.88,
TORADOL 15MG (1ML),6065130,CDM,636,RC,J1885,HCPCS,Outpatient,,,30.6,24.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.48,80,,19.58,percent of total billed charges,80% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% of total billed charges,11.4,37.27,,9.12,percent of total billed charges,37.27% 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,12.24,40,,9.79,percent of total billed charges,40% of total billed charges,11.4,24.48,
DOXEPIN 25MG CAP U/D,6400014,CDM,250,RC,,,Outpatient,,,2.85,2.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,80,,1.82,percent of total billed charges,80% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% 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,1.14,40,,0.91,percent of total billed charges,40% of total billed charges,1.06,2.28,
ZOSYN 3.375MG IV,6065130,CDM,636,RC,J2543,HCPCS,Outpatient,,,52.05,41.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.64,80,,33.31,percent of total billed charges,80% of total billed charges,19.4,37.27,,15.52,percent of total billed charges,37.27% of total billed charges,19.4,37.27,,15.52,percent of total billed charges,37.27% of total billed charges,19.4,37.27,,15.52,percent of total billed charges,37.27% 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,20.82,40,,16.66,percent of total billed charges,40% of total billed charges,19.4,41.64,
DOXEPIN 50MG CAP U/D,6400014,CDM,250,RC,,,Outpatient,,,1.9,1.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.52,80,,1.22,percent of total billed charges,80% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% 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,0.76,40,,0.61,percent of total billed charges,40% of total billed charges,0.71,1.52,
ZOFRAN INJ,6065130,CDM,636,RC,J2405,HCPCS,Outpatient,,,88.15,70.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.52,80,,56.42,percent of total billed charges,80% of total billed charges,32.85,37.27,,26.28,percent of total billed charges,37.27% of total billed charges,32.85,37.27,,26.28,percent of total billed charges,37.27% of total billed charges,32.85,37.27,,26.28,percent of total billed charges,37.27% 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,35.26,40,,28.21,percent of total billed charges,40% of total billed charges,32.85,70.52,
ADALAT CC 30MG U/D T,6400014,CDM,250,RC,,,Outpatient,,,5.8,4.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.64,80,,3.71,percent of total billed charges,80% of total billed charges,2.16,37.27,,1.73,percent of total billed charges,37.27% of total billed charges,2.16,37.27,,1.73,percent of total billed charges,37.27% of total billed charges,2.16,37.27,,1.73,percent of total billed charges,37.27% 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,2.32,40,,1.86,percent of total billed charges,40% of total billed charges,2.16,4.64,
ASPIRIN-ENTERIC COAT,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
OCUPRESS SOLN,6400014,CDM,250,RC,,,Outpatient,,,66.95,53.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.56,80,,42.85,percent of total billed charges,80% of total billed charges,24.95,37.27,,19.96,percent of total billed charges,37.27% of total billed charges,24.95,37.27,,19.96,percent of total billed charges,37.27% of total billed charges,24.95,37.27,,19.96,percent of total billed charges,37.27% 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,26.78,40,,21.42,percent of total billed charges,40% of total billed charges,24.95,53.56,
ALCONEFRIN 25 DROPS,5880901,CDM,637,RC,,,Outpatient,,,15.94,12.75,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.75,80,,10.2,percent of total billed charges,80% of total billed charges,5.94,37.27,,4.75,percent of total billed charges,37.27% of total billed charges,5.94,37.27,,4.75,percent of total billed charges,37.27% of total billed charges,5.94,37.27,,4.75,percent of total billed charges,37.27% 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,6.38,40,,5.1,percent of total billed charges,40% of total billed charges,5.94,12.75,
LORTAB-5/500 TAB UD,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
CYTOTEC 100MG TAB,6400014,CDM,250,RC,,,Outpatient,,,4.25,3.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.4,80,,2.72,percent of total billed charges,80% of total billed charges,1.58,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.58,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.58,37.27,,1.26,percent of total billed charges,37.27% 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,1.7,40,,1.36,percent of total billed charges,40% of total billed charges,1.58,3.4,
FLOVENT 110MCG INHAL,6400014,CDM,250,RC,,,Outpatient,,,213.31,170.65,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170.65,80,,136.52,percent of total billed charges,80% of total billed charges,79.5,37.27,,63.6,percent of total billed charges,37.27% of total billed charges,79.5,37.27,,63.6,percent of total billed charges,37.27% of total billed charges,79.5,37.27,,63.6,percent of total billed charges,37.27% 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,85.32,40,,68.26,percent of total billed charges,40% of total billed charges,79.5,170.65,
NAPROXEN SOD TAB 275,6400014,CDM,250,RC,,,Outpatient,,,2.85,2.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,80,,1.82,percent of total billed charges,80% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% 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,1.14,40,,0.91,percent of total billed charges,40% of total billed charges,1.06,2.28,
CALCIUM CARB SUSP 30,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
PROCRIT 20000U X20,6065130,CDM,636,RC,J0885,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,7.53,300,
ZIAC TAB 2.5 MG,6400014,CDM,250,RC,,,Outpatient,,,3.9,3.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.12,80,,2.5,percent of total billed charges,80% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% 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,1.56,40,,1.25,percent of total billed charges,40% of total billed charges,1.45,3.12,
TWOCAL HN,6400014,CDM,250,RC,,,Outpatient,,,8.3,6.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.64,80,,5.31,percent of total billed charges,80% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% 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,3.32,40,,2.66,percent of total billed charges,40% of total billed charges,3.09,6.64,
EPIVIR 150MG (LAMIVU,6400014,CDM,250,RC,,,Outpatient,,,12.67,10.14,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.14,80,,8.11,percent of total billed charges,80% of total billed charges,4.72,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.72,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.72,37.27,,3.78,percent of total billed charges,37.27% 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,5.07,40,,4.06,percent of total billed charges,40% of total billed charges,4.72,10.14,
CEPACOL 12 OZ,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
PHENOBARBITOL ELIXIR,6400014,CDM,250,RC,,,Outpatient,,,2,1.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
PROVENTIL LIQ (ALBUR,6400014,CDM,250,RC,,,Outpatient,,,2,1.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
DILOR G LIQUID (DILE,6400014,CDM,250,RC,,,Outpatient,,,2,1.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
CHERRY SYRUP (SYRPAL,6400014,CDM,250,RC,,,Outpatient,,,2,1.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
DILANTIN SUSP. 125MG,6400014,CDM,250,RC,,,Outpatient,,,15.9,12.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.72,80,,10.18,percent of total billed charges,80% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% 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,6.36,40,,5.09,percent of total billed charges,40% of total billed charges,5.93,12.72,
SYMMETREL,6400014,CDM,250,RC,,,Outpatient,,,2.11,1.69,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.69,80,,1.35,percent of total billed charges,80% of total billed charges,0.79,37.27,,0.63,percent of total billed charges,37.27% of total billed charges,0.79,37.27,,0.63,percent of total billed charges,37.27% of total billed charges,0.79,37.27,,0.63,percent of total billed charges,37.27% 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,0.84,40,,0.67,percent of total billed charges,40% of total billed charges,0.79,1.69,
KCL 10% LIQUID,5880901,CDM,637,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
RONDEC DM SYRUP,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
TYLENOL ES,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
ZANTAC,6400014,CDM,250,RC,,,Outpatient,,,12.9,10.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.32,80,,8.26,percent of total billed charges,80% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% 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,5.16,40,,4.13,percent of total billed charges,40% of total billed charges,4.81,10.32,
ELIXOPHYLLIN,6400014,CDM,250,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
ENDAL HD 5ML,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
IMMODIUM AD,6400014,CDM,250,RC,,,Outpatient,,,2,1.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
LORTAB ELIX,6400014,CDM,250,RC,,,Outpatient,,,14.2,11.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.36,80,,9.09,percent of total billed charges,80% of total billed charges,5.29,37.27,,4.23,percent of total billed charges,37.27% of total billed charges,5.29,37.27,,4.23,percent of total billed charges,37.27% of total billed charges,5.29,37.27,,4.23,percent of total billed charges,37.27% 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,5.68,40,,4.54,percent of total billed charges,40% of total billed charges,5.29,11.36,
MINERAL OIL,6400014,CDM,250,RC,,,Outpatient,,,2,1.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
NITROSTAT .4MG-1/150,6400014,CDM,250,RC,,,Outpatient,,,6.6,5.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.28,80,,4.22,percent of total billed charges,80% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% 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,2.64,40,,2.11,percent of total billed charges,40% of total billed charges,2.46,5.28,
PHENERGAN W/COD 5ML,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
PHENERGAN 5ML,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
PEDIAPRED 5ML,6400014,CDM,250,RC,,,Outpatient,,,14.25,11.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,80,,9.12,percent of total billed charges,80% of total billed charges,5.31,37.27,,4.25,percent of total billed charges,37.27% of total billed charges,5.31,37.27,,4.25,percent of total billed charges,37.27% of total billed charges,5.31,37.27,,4.25,percent of total billed charges,37.27% 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,5.7,40,,4.56,percent of total billed charges,40% of total billed charges,5.31,11.4,
KCL 20% LIQ,5880901,CDM,637,RC,,,Outpatient,,,28.35,22.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.68,80,,18.14,percent of total billed charges,80% of total billed charges,10.57,37.27,,8.46,percent of total billed charges,37.27% of total billed charges,10.57,37.27,,8.46,percent of total billed charges,37.27% of total billed charges,10.57,37.27,,8.46,percent of total billed charges,37.27% 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,11.34,40,,9.07,percent of total billed charges,40% of total billed charges,10.57,22.68,
ACCOLATE 20MG TAB UD,6400014,CDM,250,RC,,,Outpatient,,,7.75,6.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.2,80,,4.96,percent of total billed charges,80% of total billed charges,2.89,37.27,,2.31,percent of total billed charges,37.27% of total billed charges,2.89,37.27,,2.31,percent of total billed charges,37.27% of total billed charges,2.89,37.27,,2.31,percent of total billed charges,37.27% 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,3.1,40,,2.48,percent of total billed charges,40% of total billed charges,2.89,6.2,
ACETAMINOPHEN 325MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ACETAMINOPHEN/COD EL,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
ACETAMINOPHEN/COD EL,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
AMPICILLIN 250MG CAP,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
ACETAZOLAMIDE 250MG,6400014,CDM,250,RC,,,Outpatient,,,14.25,11.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.4,80,,9.12,percent of total billed charges,80% of total billed charges,5.31,37.27,,4.25,percent of total billed charges,37.27% of total billed charges,5.31,37.27,,4.25,percent of total billed charges,37.27% of total billed charges,5.31,37.27,,4.25,percent of total billed charges,37.27% 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,5.7,40,,4.56,percent of total billed charges,40% of total billed charges,5.31,11.4,
DOXEPIN 10MG CAP U/D,6400014,CDM,250,RC,,,Outpatient,,,2.2,1.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,80,,1.41,percent of total billed charges,80% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% 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,0.88,40,,0.7,percent of total billed charges,40% of total billed charges,0.82,1.76,
ACYCLOVIR 400MG TAB,6400014,CDM,250,RC,,,Outpatient,,,7.35,5.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.88,80,,4.7,percent of total billed charges,80% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% 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,2.94,40,,2.35,percent of total billed charges,40% of total billed charges,2.74,5.88,
ADALAT CC 60MG TAB U,6400014,CDM,250,RC,,,Outpatient,,,11.9,9.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.52,80,,7.62,percent of total billed charges,80% of total billed charges,4.44,37.27,,3.55,percent of total billed charges,37.27% of total billed charges,4.44,37.27,,3.55,percent of total billed charges,37.27% of total billed charges,4.44,37.27,,3.55,percent of total billed charges,37.27% 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,4.76,40,,3.81,percent of total billed charges,40% of total billed charges,4.44,9.52,
STOCKING JOBST KNEE,5645742,CDM,270,RC,A6532,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% 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,150,40,,120,percent of total billed charges,40% of total billed charges,139.76,300,
KNEE BRACE HINGED,5645742,CDM,270,RC,,,Outpatient,,,247,197.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,92.06,37.27,,73.65,percent of total billed charges,37.27% of total billed charges,92.06,37.27,,73.65,percent of total billed charges,37.27% of total billed charges,92.06,37.27,,73.65,percent of total billed charges,37.27% 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,98.8,40,,79.04,percent of total billed charges,40% of total billed charges,92.06,197.6,
PT T.E.N.S PER UNIT,6610133,CDM,420,RC,64550,HCPCS,Outpatient,,,112,89.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% 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,44.8,40,,35.84,percent of total billed charges,40% of total billed charges,41.74,89.6,
PT THERAPY EVALUATIO,6639520,CDM,424,RC,97001,HCPCS,Outpatient,,,283,226.40,GP,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% 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,113.2,40,,90.56,percent of total billed charges,40% of total billed charges,105.47,226.4,
ST HEARING SCREENING,6739411,CDM,470,RC,92551,HCPCS,Outpatient,,,42,33.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.18,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,40,,13.44,percent of total billed charges,40% of total billed charges,15.65,33.6,
ST/HEARING EVAL PER,6739429,CDM,440,RC,92506,HCPCS,Outpatient,,,561,448.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% 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,224.4,40,,179.52,percent of total billed charges,40% of total billed charges,209.08,448.8,
KLONOPIN (CLONAZEPAM,7000029,CDM,301,RC,80346,HCPCS,Outpatient,,,228.86,183.09,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.09,80,,146.47,percent of total billed charges,80% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% 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,91.54,40,,73.23,percent of total billed charges,40% of total billed charges,85.3,183.09,
TOFRANIL (IMIPRAMINE,7000029,CDM,301,RC,80335,HCPCS,Outpatient,,,136,108.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% 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,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,50.69,108.8,
LBC AB ID SELECT CEL,7000169,CDM,302,RC,86870,HCPCS,Outpatient,,,259,207.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,207.2,80,,165.76,percent of total billed charges,80% of total billed charges,96.53,37.27,,77.22,percent of total billed charges,37.27% of total billed charges,96.53,37.27,,77.22,percent of total billed charges,37.27% of total billed charges,96.53,37.27,,77.22,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.6,40,,82.88,percent of total billed charges,40% of total billed charges,96.53,296.36,
LBC ANTIBODY IDENTIF,7000169,CDM,302,RC,86870,HCPCS,Outpatient,,,322,257.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,120.01,37.27,,96.01,percent of total billed charges,37.27% of total billed charges,120.01,37.27,,96.01,percent of total billed charges,37.27% of total billed charges,120.01,37.27,,96.01,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.8,40,,103.04,percent of total billed charges,40% of total billed charges,120.01,296.36,
"BLOOD GROUP, A,B,O",7000169,CDM,302,RC,86900,HCPCS,Outpatient,,,135,108.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108,80,,86.4,percent of total billed charges,80% of total billed charges,50.31,37.27,,40.25,percent of total billed charges,37.27% of total billed charges,50.31,37.27,,40.25,percent of total billed charges,37.27% of total billed charges,50.31,37.27,,40.25,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,2.99,100,,,fee schedule,100% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54,40,,43.2,percent of total billed charges,40% of total billed charges,2.99,108,
CANDIDA SKIN TEST,7000169,CDM,302,RC,86485,HCPCS,Outpatient,,,108,86.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,24.55,86.4,
DIRECT COOMBS,7000169,CDM,302,RC,86880,HCPCS,Outpatient,,,48,38.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,5.39,100,,,fee schedule,100% of CMS fee schedule,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,40,,15.36,percent of total billed charges,40% of total billed charges,5.39,50.43,
CREATININE,7000029,CDM,301,RC,,,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% 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,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,18.26,39.2,
BLOOD ALCOHOL,7000029,CDM,301,RC,80320,HCPCS,Outpatient,,,280,224.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224,80,,179.2,percent of total billed charges,80% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% 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,112,40,,89.6,percent of total billed charges,40% of total billed charges,104.36,224,
CROSSMATCH - 1,7000169,CDM,302,RC,86922,HCPCS,Outpatient,,,260,208.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,80,,166.4,percent of total billed charges,80% of total billed charges,96.9,37.27,,77.52,percent of total billed charges,37.27% of total billed charges,96.9,37.27,,77.52,percent of total billed charges,37.27% of total billed charges,96.9,37.27,,77.52,percent of total billed charges,37.27% of total billed charges,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104,40,,83.2,percent of total billed charges,40% of total billed charges,96.9,208,
DOXEPIN (SINEQUAN),7000029,CDM,301,RC,80335,HCPCS,Outpatient,,,136,108.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% 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,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,50.69,108.8,
NORTRIPTYLINE,7000029,CDM,301,RC,80335,HCPCS,Outpatient,,,144,115.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% 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,57.6,40,,46.08,percent of total billed charges,40% of total billed charges,53.67,115.2,
CHAIN OF CUSTODY COL,7012032,CDM,300,RC,99001,HCPCS,Outpatient,,,38,30.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% 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,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,14.16,30.4,
"LBC ANTIBODY ID,COLD",7000169,CDM,302,RC,86870,HCPCS,Outpatient,,,337,269.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,269.6,80,,215.68,percent of total billed charges,80% of total billed charges,125.6,37.27,,100.48,percent of total billed charges,37.27% of total billed charges,125.6,37.27,,100.48,percent of total billed charges,37.27% of total billed charges,125.6,37.27,,100.48,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.8,40,,107.84,percent of total billed charges,40% of total billed charges,125.6,296.36,
SURGICUTT DEVICE,5645742,CDM,270,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
ANTIGEN TYPE.GRP I,7000169,CDM,302,RC,86905,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,3.83,100,,,fee schedule,100% of CMS fee schedule,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,3.83,296.36,
ANTIBODY ID,7000169,CDM,302,RC,86870,HCPCS,Outpatient,,,430.86,344.69,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344.69,80,,275.75,percent of total billed charges,80% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.34,40,,137.87,percent of total billed charges,40% of total billed charges,160.58,344.69,
TYPE & SCREEN,7000169,CDM,302,RC,86850,HCPCS,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,9.77,100,,,fee schedule,100% of CMS fee schedule,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,9.77,44.67,
DRUG SCN-HEALTH PROF,7012032,CDM,300,RC,,,Outpatient,,,113,90.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% 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,45.2,40,,36.16,percent of total billed charges,40% of total billed charges,42.12,90.4,
NICOTINE,7000029,CDM,301,RC,80323,HCPCS,Outpatient,,,140,112.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112,80,,89.6,percent of total billed charges,80% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% 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,56,40,,44.8,percent of total billed charges,40% of total billed charges,52.18,112,
MOLECULAR INTERPRETA,7000029,CDM,301,RC,83912,HCPCS,Outpatient,,,90,72.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% 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,36,40,,28.8,percent of total billed charges,40% of total billed charges,33.54,72,
"THAWING UNIT, EACH U",7000169,CDM,302,RC,86927,HCPCS,Outpatient,,,430.86,344.69,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344.69,80,,275.75,percent of total billed charges,80% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.34,40,,137.87,percent of total billed charges,40% of total billed charges,140.82,344.69,
ANTIGEN SCN PER UNIT,7000169,CDM,302,RC,86902,HCPCS,Outpatient,,,430.86,344.69,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344.69,80,,275.75,percent of total billed charges,80% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,6.35,100,,,fee schedule,100% of CMS fee schedule,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.34,40,,137.87,percent of total billed charges,40% of total billed charges,6.35,344.69,
LBC SELECTCELL SCRN,7000169,CDM,302,RC,86850,HCPCS,Outpatient,,,203,162.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,9.77,100,,,fee schedule,100% of CMS fee schedule,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.2,40,,64.96,percent of total billed charges,40% of total billed charges,9.77,162.4,
CARDIAC PROFILE,7012032,CDM,300,RC,,,Outpatient,,,165,132.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% 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,66,40,,52.8,percent of total billed charges,40% of total billed charges,61.5,132,
CRYOPRECIPITATE,7000169,CDM,302,RC,86932,HCPCS,Outpatient,,,164,131.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,61.12,37.27,,48.9,percent of total billed charges,37.27% of total billed charges,61.12,37.27,,48.9,percent of total billed charges,37.27% of total billed charges,61.12,37.27,,48.9,percent of total billed charges,37.27% of total billed charges,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,40,,52.48,percent of total billed charges,40% of total billed charges,33.06,131.2,
"BLOOD TYPE, RH (D)",7000169,CDM,302,RC,86901,HCPCS,Outpatient,,,43,34.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,2.99,100,,,fee schedule,100% of CMS fee schedule,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.2,40,,13.76,percent of total billed charges,40% of total billed charges,2.99,34.4,
BLOOD ADMINISTRATION,5811120,CDM,391,RC,36430,HCPCS,Outpatient,,,1034,827.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,827.2,80,,661.76,percent of total billed charges,80% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,54.09,145,,,fee schedule,145% of CMS fee schedule,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413.6,40,,330.88,percent of total billed charges,40% of total billed charges,54.09,827.2,
MOLECULAR SEPARATION,7000029,CDM,301,RC,83894,HCPCS,Outpatient,,,90,72.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% 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,36,40,,28.8,percent of total billed charges,40% of total billed charges,33.54,72,
DRUG SCREEN-THC,7000029,CDM,301,RC,80349,HCPCS,Outpatient,,,228.86,183.09,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.09,80,,146.47,percent of total billed charges,80% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% 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,91.54,40,,73.23,percent of total billed charges,40% of total billed charges,85.3,183.09,
DRUG SCREEN-OPIATES,7000029,CDM,301,RC,80361,HCPCS,Outpatient,,,228.26,182.61,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,182.61,80,,146.09,percent of total billed charges,80% of total billed charges,85.07,37.27,,68.06,percent of total billed charges,37.27% of total billed charges,85.07,37.27,,68.06,percent of total billed charges,37.27% of total billed charges,85.07,37.27,,68.06,percent of total billed charges,37.27% 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,91.3,40,,73.04,percent of total billed charges,40% of total billed charges,85.07,182.61,
DRUG SCREEN-BARBITU,7000029,CDM,301,RC,80345,HCPCS,Outpatient,,,228.86,183.09,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.09,80,,146.47,percent of total billed charges,80% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% 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,91.54,40,,73.23,percent of total billed charges,40% of total billed charges,85.3,183.09,
HBOT PER 30 MIN,7100332,CDM,413,RC,G0277,HCPCS,Outpatient,,,257,205.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,205.6,80,,164.48,percent of total billed charges,80% of total billed charges,95.78,37.27,,76.62,percent of total billed charges,37.27% of total billed charges,95.78,37.27,,76.62,percent of total billed charges,37.27% of total billed charges,95.78,37.27,,76.62,percent of total billed charges,37.27% of total billed charges,114.41,100,,,fee schedule,100% of APC rate,114.41,100,,,fee schedule,100% of APC rate,114.41,100,,,fee schedule,100% of APC rate,231.8,145,,,fee schedule,145% of CMS fee schedule,114.41,100,,,fee schedule,100% of APC rate,114.41,100,,,fee schedule,100% of APC rate,114.41,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.8,40,,82.24,percent of total billed charges,40% of total billed charges,95.78,231.8,
HT ABI 1-2 LEVELS,7100340,CDM,920,RC,93922,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,89.89,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,89.89,264,
ABI BILAT 3 + LEVEL,6012447,CDM,921,RC,93923,HCPCS,Outpatient,,,340,272.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272,80,,217.6,percent of total billed charges,80% of total billed charges,126.72,37.27,,101.38,percent of total billed charges,37.27% of total billed charges,126.72,37.27,,101.38,percent of total billed charges,37.27% of total billed charges,126.72,37.27,,101.38,percent of total billed charges,37.27% of total billed charges,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,138.65,145,,,fee schedule,145% of CMS fee schedule,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136,40,,108.8,percent of total billed charges,40% of total billed charges,126.72,272,
CHEMICAL CAUTERIZ,5612346,CDM,761,RC,17250,HCPCS,Outpatient,,,459.15,367.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,367.32,80,,293.86,percent of total billed charges,80% of total billed charges,171.13,37.27,,136.9,percent of total billed charges,37.27% of total billed charges,171.13,37.27,,136.9,percent of total billed charges,37.27% of total billed charges,171.13,37.27,,136.9,percent of total billed charges,37.27% of total billed charges,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,51.79,145,,,fee schedule,145% of CMS fee schedule,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.66,40,,146.93,percent of total billed charges,40% of total billed charges,51.79,367.32,
DEB SUBQ 20 SQCM/<,5612346,CDM,761,RC,11042,HCPCS,Outpatient,,,877.47,701.98,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,701.98,80,,561.58,percent of total billed charges,80% of total billed charges,327.03,37.27,,261.62,percent of total billed charges,37.27% of total billed charges,327.03,37.27,,261.62,percent of total billed charges,37.27% of total billed charges,327.03,37.27,,261.62,percent of total billed charges,37.27% of total billed charges,328.76,100,,,fee schedule,100% of APC rate,328.76,100,,,fee schedule,100% of APC rate,328.76,100,,,fee schedule,100% of APC rate,84.25,145,,,fee schedule,145% of CMS fee schedule,328.76,100,,,fee schedule,100% of APC rate,328.76,100,,,fee schedule,100% of APC rate,328.76,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.99,40,,280.79,percent of total billed charges,40% of total billed charges,84.25,701.98,
APPLIC UNNA BOOT RT,5612346,CDM,761,RC,29580,HCPCS,Outpatient,,,375.3,300.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300.24,80,,240.19,percent of total billed charges,80% of total billed charges,139.87,37.27,,111.9,percent of total billed charges,37.27% of total billed charges,139.87,37.27,,111.9,percent of total billed charges,37.27% of total billed charges,139.87,37.27,,111.9,percent of total billed charges,37.27% of total billed charges,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,37.16,145,,,fee schedule,145% of CMS fee schedule,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.12,40,,120.1,percent of total billed charges,40% of total billed charges,37.16,300.24,
SUREPRESS COMP BA,5645742,CDM,270,RC,,,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% 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,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,18.26,39.2,
WH DRESSING IODOSORB,5801832,CDM,272,RC,,,Outpatient,,,92,73.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% 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,36.8,40,,29.44,percent of total billed charges,40% of total billed charges,34.29,73.6,
DRESSING TELFA ISLAN,5801832,CDM,272,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
APLIGRAF,6065130,CDM,636,RC,Q4101,HCPCS,Outpatient,,,1322,1057.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1057.6,80,,846.08,percent of total billed charges,80% of total billed charges,492.71,37.27,,394.17,percent of total billed charges,37.27% of total billed charges,492.71,37.27,,394.17,percent of total billed charges,37.27% of total billed charges,492.71,37.27,,394.17,percent of total billed charges,37.27% 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,528.8,40,,423.04,percent of total billed charges,40% of total billed charges,492.71,1057.6,
DRESSING MEPILEX,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
NP VISIT LEVEL 1,5612353,CDM,510,RC,99201,HCPCS,Outpatient,,,319.68,255.74,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,255.74,80,,204.59,percent of total billed charges,80% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% 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,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,96.04,255.74,
NP VISIT LEVEL 2,5612353,CDM,510,RC,99202,HCPCS,Outpatient,,,319.68,255.74,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,255.74,80,,204.59,percent of total billed charges,80% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.21,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,66.21,255.74,
EP VISIT LEVEL 1,5612353,CDM,510,RC,99211,HCPCS,Outpatient,,,319.68,255.74,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,255.74,80,,204.59,percent of total billed charges,80% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.19,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,12.19,255.74,
EP VISIT LEVEL 2,5612353,CDM,510,RC,99212,HCPCS,Outpatient,,,319.68,255.74,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,255.74,80,,204.59,percent of total billed charges,80% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.36,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,49.36,255.74,
DEB MUS/FAS20 SQCM/<,5612346,CDM,761,RC,11043,HCPCS,Outpatient,,,1358.73,1086.98,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1086.98,80,,869.58,percent of total billed charges,80% of total billed charges,506.4,37.27,,405.12,percent of total billed charges,37.27% of total billed charges,506.4,37.27,,405.12,percent of total billed charges,37.27% of total billed charges,506.4,37.27,,405.12,percent of total billed charges,37.27% of total billed charges,517.83,100,,,fee schedule,100% of APC rate,517.83,100,,,fee schedule,100% of APC rate,517.83,100,,,fee schedule,100% of APC rate,214.98,145,,,fee schedule,145% of CMS fee schedule,517.83,100,,,fee schedule,100% of APC rate,517.83,100,,,fee schedule,100% of APC rate,517.83,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,543.49,40,,434.79,percent of total billed charges,40% of total billed charges,214.98,1086.98,
DEB BONE 20 SQ CM/<,5612346,CDM,761,RC,11044,HCPCS,Outpatient,,,3708.3,2966.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2966.64,80,,2373.31,percent of total billed charges,80% of total billed charges,1382.08,37.27,,1105.66,percent of total billed charges,37.27% of total billed charges,1382.08,37.27,,1105.66,percent of total billed charges,37.27% of total billed charges,1382.08,37.27,,1105.66,percent of total billed charges,37.27% of total billed charges,1336.76,100,,,fee schedule,100% of APC rate,1336.76,100,,,fee schedule,100% of APC rate,1336.76,100,,,fee schedule,100% of APC rate,317.2,145,,,fee schedule,145% of CMS fee schedule,1336.76,100,,,fee schedule,100% of APC rate,1336.76,100,,,fee schedule,100% of APC rate,1336.76,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1483.32,40,,1186.66,percent of total billed charges,40% of total billed charges,317.2,2966.64,
CALLUS REDUCE 2-4,5612346,CDM,761,RC,11056,HCPCS,Outpatient,,,551,440.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,440.8,80,,352.64,percent of total billed charges,80% of total billed charges,205.36,37.27,,164.29,percent of total billed charges,37.27% of total billed charges,205.36,37.27,,164.29,percent of total billed charges,37.27% of total billed charges,205.36,37.27,,164.29,percent of total billed charges,37.27% of total billed charges,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,30.99,145,,,fee schedule,145% of CMS fee schedule,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220.4,40,,176.32,percent of total billed charges,40% of total billed charges,30.99,440.8,
DRESSING IDOFLEX,5645742,CDM,270,RC,,,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% 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,28,40,,22.4,percent of total billed charges,40% of total billed charges,26.09,56,
ACTICOAT ABSORBANT R,5645742,CDM,270,RC,,,Outpatient,,,44,35.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% 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,17.6,40,,14.08,percent of total billed charges,40% of total billed charges,16.4,35.2,
ACTICOAT ANTIMICROBI,5645742,CDM,270,RC,,,Outpatient,,,47,37.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% 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,18.8,40,,15.04,percent of total billed charges,40% of total billed charges,17.52,37.6,
ACTICOAT ABSORBANT A,5645742,CDM,270,RC,,,Outpatient,,,88,70.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% 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,35.2,40,,28.16,percent of total billed charges,40% of total billed charges,32.8,70.4,
ACTICOAT FOAM,5645742,CDM,270,RC,,,Outpatient,,,54,43.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.2,80,,34.56,percent of total billed charges,80% of total billed charges,20.13,37.27,,16.1,percent of total billed charges,37.27% of total billed charges,20.13,37.27,,16.1,percent of total billed charges,37.27% of total billed charges,20.13,37.27,,16.1,percent of total billed charges,37.27% 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,21.6,40,,17.28,percent of total billed charges,40% of total billed charges,20.13,43.2,
HEEL/ELBOW PROTECTOR,5645742,CDM,270,RC,,,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% 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,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,14.54,31.2,
SHOE PROTECT WM M-1,5645742,CDM,270,RC,,,Outpatient,,,56,44.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% 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,22.4,40,,17.92,percent of total billed charges,40% of total billed charges,20.87,44.8,
SILVER NITRATE ST,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
STERI STRIP 1/4 X 1,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
NP VISIT LEVEL 3,5612353,CDM,510,RC,99203,HCPCS,Outpatient,,,250,200.00,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,200,80,,160,percent of total billed charges,80% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.81,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,93.18,200,
EP VISIT LEVEL 3,5612353,CDM,510,RC,99213,HCPCS,Outpatient,,,319.68,255.74,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,255.74,80,,204.59,percent of total billed charges,80% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.94,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,91.94,255.74,
TUBE ENDO LASER SHLD,5645742,CDM,270,RC,,,Outpatient,,,196,156.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% 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,78.4,40,,62.72,percent of total billed charges,40% of total billed charges,73.05,156.8,
IV CATH UNIT 14G,5645742,CDM,270,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
ANESTHESIA 1ST HR,7231004,CDM,370,RC,,,Outpatient,,,1020,816.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,816,80,,652.8,percent of total billed charges,80% of total billed charges,380.15,37.27,,304.12,percent of total billed charges,37.27% of total billed charges,380.15,37.27,,304.12,percent of total billed charges,37.27% of total billed charges,380.15,37.27,,304.12,percent of total billed charges,37.27% 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,408,40,,326.4,percent of total billed charges,40% of total billed charges,380.15,816,
ANESTHESIA ADD 30 MN,7231004,CDM,370,RC,,,Outpatient,,,178,142.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,142.4,80,,113.92,percent of total billed charges,80% of total billed charges,66.34,37.27,,53.07,percent of total billed charges,37.27% of total billed charges,66.34,37.27,,53.07,percent of total billed charges,37.27% of total billed charges,66.34,37.27,,53.07,percent of total billed charges,37.27% 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,71.2,40,,56.96,percent of total billed charges,40% of total billed charges,66.34,142.4,
ANES VENTILATOR ADLT,5645742,CDM,270,RC,,,Outpatient,,,23,18.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% 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,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,8.57,18.4,
TUBE ORAL RAE CUFFED,5645742,CDM,270,RC,,,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
TUBE NASAL RAE CUFFD,5645742,CDM,270,RC,,,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
UNI-FILTERS,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
ESOPH STETH TEMP PRB,5645742,CDM,270,RC,,,Outpatient,,,22,17.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% 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,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,8.2,17.6,
TUBE NASAL RAE UNCUF,5645742,CDM,270,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
TUBING PRESSURE MALE,5645742,CDM,270,RC,,,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% 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,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,8.94,19.2,
ANES VENTILATOR PEDI,5645742,CDM,270,RC,,,Outpatient,,,26,20.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% 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,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,9.69,20.8,
MASK NON-REBREATHING,5645742,CDM,270,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
LMA FASTRACH,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
BREATHING CIR W/MASK,5645742,CDM,270,RC,,,Outpatient,,,38,30.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% 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,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,14.16,30.4,
MASK OXYGEN ADULT,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
BLANKET BAIR LOWER,5645742,CDM,270,RC,,,Outpatient,,,67,53.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% 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,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,24.97,53.6,
CO2 ANALYZER,5645742,CDM,270,RC,,,Outpatient,,,68,54.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% 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,27.2,40,,21.76,percent of total billed charges,40% of total billed charges,25.34,54.4,
LARYNGEOSCOPE FIBER,5645742,CDM,270,RC,,,Outpatient,,,68,54.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% 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,27.2,40,,21.76,percent of total billed charges,40% of total billed charges,25.34,54.4,
AIRWAY MASK LARY,5645742,CDM,270,RC,,,Outpatient,,,26,20.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% 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,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,9.69,20.8,
SPINAL ANES TRAY,5645742,CDM,270,RC,,,Outpatient,,,63.15,50.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.52,80,,40.42,percent of total billed charges,80% of total billed charges,23.54,37.27,,18.83,percent of total billed charges,37.27% of total billed charges,23.54,37.27,,18.83,percent of total billed charges,37.27% of total billed charges,23.54,37.27,,18.83,percent of total billed charges,37.27% 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,25.26,40,,20.21,percent of total billed charges,40% of total billed charges,23.54,50.52,
BIER BLOCK TOURNIQUE,5645742,CDM,270,RC,,,Outpatient,,,22,17.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% 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,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,8.2,17.6,
TUBE ENDOBRONCHIAL,5645742,CDM,270,RC,,,Outpatient,,,106,84.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% 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,42.4,40,,33.92,percent of total billed charges,40% of total billed charges,39.51,84.8,
MDI SPACER MED MASK,5645742,CDM,270,RC,,,Outpatient,,,58,46.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% 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,23.2,40,,18.56,percent of total billed charges,40% of total billed charges,21.62,46.4,
MDI SPACER WITH FLOW,5645742,CDM,270,RC,,,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% 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,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,10.44,22.4,
MDI SPACER WITH MV 1,5645742,CDM,270,RC,,,Outpatient,,,26,20.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% 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,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,9.69,20.8,
AEROSOL T PIECE ADAP,5645742,CDM,270,RC,,,Outpatient,,,2,1.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
CORRI TUBING 6FT,5645742,CDM,270,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
HAND HELD NEB CIRCUI,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
PULMONARY MECHANICS,7439094,CDM,410,RC,94799,HCPCS,Outpatient,,,300,240.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,111.81,240,
MASK AEROSOL,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
MASK VENTI,5645742,CDM,270,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
CANNULA NASAL OXYGEN,5645742,CDM,270,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
CHST PHY THERAPY-INI,7439094,CDM,410,RC,94667,HCPCS,Outpatient,,,231,184.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,31.96,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.4,40,,73.92,percent of total billed charges,40% of total billed charges,31.96,184.8,
CHST PHY THERAPY-SUB,7439094,CDM,410,RC,94668,HCPCS,Outpatient,,,231,184.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.8,80,,147.84,percent of total billed charges,80% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% of total billed charges,86.09,37.27,,68.87,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,50.27,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.4,40,,73.92,percent of total billed charges,40% of total billed charges,50.27,184.8,
PULSE OX SINGLE,7441215,CDM,460,RC,94760,HCPCS,Outpatient,,,47,37.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.51,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.8,40,,15.04,percent of total billed charges,40% of total billed charges,3.51,37.6,
PF W/LUNG VOL W/ BD,7441215,CDM,460,RC,94060,HCPCS,Outpatient,,,561,448.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% of total billed charges,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,36.9,145,,,fee schedule,145% of CMS fee schedule,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.4,40,,179.52,percent of total billed charges,40% of total billed charges,36.9,448.8,
PF W/LUNG VOL W/O BD,7441215,CDM,460,RC,94010,HCPCS,Outpatient,,,393,314.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.4,80,,251.52,percent of total billed charges,80% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% of total billed charges,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,24.65,145,,,fee schedule,145% of CMS fee schedule,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.2,40,,125.76,percent of total billed charges,40% of total billed charges,24.65,314.4,
PF WITHOUT BD,7441215,CDM,460,RC,94010,HCPCS,Outpatient,,,300,240.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,24.65,145,,,fee schedule,145% of CMS fee schedule,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,24.65,240,
VENT CIRCUIT ADULT,5645742,CDM,270,RC,,,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% 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,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,10.44,22.4,
IPPB CIRCUIT UNIVERS,5645742,CDM,270,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
RESP CATH ASPIRATION,7439094,CDM,410,RC,31720,HCPCS,Outpatient,,,410,328.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328,80,,262.4,percent of total billed charges,80% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,67.83,145,,,fee schedule,145% of CMS fee schedule,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164,40,,131.2,percent of total billed charges,40% of total billed charges,67.83,328,
PF WITH BD,7441215,CDM,460,RC,94060,HCPCS,Outpatient,,,561,448.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% of total billed charges,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,36.9,145,,,fee schedule,145% of CMS fee schedule,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.4,40,,179.52,percent of total billed charges,40% of total billed charges,36.9,448.8,
IPPB TX INITIAL,7439094,CDM,410,RC,94640,HCPCS,Outpatient,,,410,328.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328,80,,262.4,percent of total billed charges,80% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,10.27,145,,,fee schedule,145% of CMS fee schedule,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164,40,,131.2,percent of total billed charges,40% of total billed charges,10.27,328,
IPPB TX SUBSEQUENT,7439094,CDM,410,RC,94640,HCPCS,Outpatient,,,410,328.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328,80,,262.4,percent of total billed charges,80% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,10.27,145,,,fee schedule,145% of CMS fee schedule,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164,40,,131.2,percent of total billed charges,40% of total billed charges,10.27,328,
PF DIFFUSION STUDIES,7441215,CDM,460,RC,94729,HCPCS,Outpatient,,,168,134.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,40,,53.76,percent of total billed charges,40% of total billed charges,61,134.4,
CPR CODE 4,7442254,CDM,480,RC,92950,HCPCS,Outpatient,,,590,472.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472,80,,377.6,percent of total billed charges,80% of total billed charges,219.89,37.27,,175.91,percent of total billed charges,37.27% of total billed charges,219.89,37.27,,175.91,percent of total billed charges,37.27% of total billed charges,219.89,37.27,,175.91,percent of total billed charges,37.27% of total billed charges,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,257.85,145,,,fee schedule,145% of CMS fee schedule,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236,40,,188.8,percent of total billed charges,40% of total billed charges,219.89,472,
VENT INITIAL DAY,7439094,CDM,410,RC,94002,HCPCS,Outpatient,,,758,606.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,606.4,80,,485.12,percent of total billed charges,80% of total billed charges,282.51,37.27,,226.01,percent of total billed charges,37.27% of total billed charges,282.51,37.27,,226.01,percent of total billed charges,37.27% of total billed charges,282.51,37.27,,226.01,percent of total billed charges,37.27% of total billed charges,516.69,100,,,fee schedule,100% of APC rate,516.69,100,,,fee schedule,100% of APC rate,516.69,100,,,fee schedule,100% of APC rate,128.14,145,,,fee schedule,145% of CMS fee schedule,516.69,100,,,fee schedule,100% of APC rate,516.69,100,,,fee schedule,100% of APC rate,516.69,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,303.2,40,,242.56,percent of total billed charges,40% of total billed charges,128.14,606.4,
RESP INTUB ET EMER,7439094,CDM,410,RC,31500,HCPCS,Outpatient,,,646,516.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,199.82,145,,,fee schedule,145% of CMS fee schedule,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,258.4,40,,206.72,percent of total billed charges,40% of total billed charges,199.82,516.8,
VENT SUB DAY,7439094,CDM,410,RC,94003,HCPCS,Outpatient,,,617,493.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,493.6,80,,394.88,percent of total billed charges,80% of total billed charges,229.96,37.27,,183.97,percent of total billed charges,37.27% of total billed charges,229.96,37.27,,183.97,percent of total billed charges,37.27% of total billed charges,229.96,37.27,,183.97,percent of total billed charges,37.27% of total billed charges,516.69,100,,,fee schedule,100% of APC rate,516.69,100,,,fee schedule,100% of APC rate,516.69,100,,,fee schedule,100% of APC rate,89.94,145,,,fee schedule,145% of CMS fee schedule,516.69,100,,,fee schedule,100% of APC rate,516.69,100,,,fee schedule,100% of APC rate,516.69,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.8,40,,197.44,percent of total billed charges,40% of total billed charges,89.94,516.69,
CPAP CANNULA,5645742,CDM,270,RC,,,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% 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,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,10.44,22.4,
OXYGEN SPLY TBNG CN,5645742,CDM,270,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
MASK TRACH,5645742,CDM,270,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
OXYGEN PER HR,5645742,CDM,270,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
MASK OXYGEN FACE TNT,5645742,CDM,270,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
AMBU BAG DISP,5645742,CDM,270,RC,,,Outpatient,,,108,86.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% 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,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,40.25,86.4,
HUMIDIFIER OXYGEN DI,5645742,CDM,270,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
HNHLD NEB DEMO/EVAL,7439094,CDM,410,RC,94664,HCPCS,Outpatient,,,410,328.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328,80,,262.4,percent of total billed charges,80% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,23.08,145,,,fee schedule,145% of CMS fee schedule,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164,40,,131.2,percent of total billed charges,40% of total billed charges,23.08,328,
OXYGEN CONN TUBE,5645742,CDM,270,RC,,,Outpatient,,,4,3.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
AEROSOL EFFUSION BAG,5645742,CDM,270,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
VENTILATOR CANNISTER,5645742,CDM,270,RC,,,Outpatient,,,41,32.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% 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,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,15.28,32.8,
NEBULIZER INITIAL TX,7439094,CDM,410,RC,94640,HCPCS,Outpatient,,,635,508.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,508,80,,406.4,percent of total billed charges,80% of total billed charges,236.66,37.27,,189.33,percent of total billed charges,37.27% of total billed charges,236.66,37.27,,189.33,percent of total billed charges,37.27% of total billed charges,236.66,37.27,,189.33,percent of total billed charges,37.27% of total billed charges,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,10.27,145,,,fee schedule,145% of CMS fee schedule,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,254,40,,203.2,percent of total billed charges,40% of total billed charges,10.27,508,
MASK OXYGEN PEDI,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
ENDO TUBE HOLDER,5645742,CDM,270,RC,,,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% 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,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,8.94,19.2,
SPUTUM COLLECTION,5645742,CDM,270,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
RT MTRD DOSE TX INIT,7439094,CDM,410,RC,94640,HCPCS,Outpatient,,,410,328.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328,80,,262.4,percent of total billed charges,80% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,10.27,145,,,fee schedule,145% of CMS fee schedule,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164,40,,131.2,percent of total billed charges,40% of total billed charges,10.27,328,
RT MTRD DOSE TX SUBS,7439094,CDM,410,RC,94640,HCPCS,Outpatient,,,,,76,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.85,175.85,
ABG KIT QUICK DRAW,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
ECHO 2-D,7442254,CDM,480,RC,93307,HCPCS,Outpatient,,,674,539.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,539.2,80,,431.36,percent of total billed charges,80% of total billed charges,251.2,37.27,,200.96,percent of total billed charges,37.27% of total billed charges,251.2,37.27,,200.96,percent of total billed charges,37.27% of total billed charges,251.2,37.27,,200.96,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,119.48,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,269.6,40,,215.68,percent of total billed charges,40% of total billed charges,119.48,539.2,
ECHO W/DOPPLER,7442254,CDM,480,RC,93320,HCPCS,Outpatient,,,674,539.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,539.2,80,,431.36,percent of total billed charges,80% of total billed charges,251.2,37.27,,200.96,percent of total billed charges,37.27% of total billed charges,251.2,37.27,,200.96,percent of total billed charges,37.27% of total billed charges,251.2,37.27,,200.96,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.4,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,269.6,40,,215.68,percent of total billed charges,40% of total billed charges,42.4,539.2,
ECHO W/COLOR FLOW,7442254,CDM,480,RC,93325,HCPCS,Outpatient,,,674,539.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,539.2,80,,431.36,percent of total billed charges,80% of total billed charges,251.2,37.27,,200.96,percent of total billed charges,37.27% of total billed charges,251.2,37.27,,200.96,percent of total billed charges,37.27% of total billed charges,251.2,37.27,,200.96,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.78,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,269.6,40,,215.68,percent of total billed charges,40% of total billed charges,25.78,539.2,
NACL PER TX 0.9%/5ML,6400014,CDM,250,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
MUCOMYST PER TX,6400014,CDM,250,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
VAPO NEPHRINE PER TX,6400014,CDM,250,RC,,,Outpatient,,,2,1.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.6,80,,1.28,percent of total billed charges,80% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% of total billed charges,0.75,37.27,,0.6,percent of total billed charges,37.27% 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,0.8,40,,0.64,percent of total billed charges,40% of total billed charges,0.75,1.6,
ALUPENT PER TX,6400014,CDM,250,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
TERBUTALINE PER TX,6400014,CDM,250,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
PROVENTIL 2.5MG/BOTT,6400014,CDM,250,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
ATROVENT 0.02% PER T,6400014,CDM,250,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
EEG AWAKE/ASLEEP,7612344,CDM,740,RC,95819,HCPCS,Outpatient,,,825,660.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,660,80,,528,percent of total billed charges,80% of total billed charges,307.48,37.27,,245.98,percent of total billed charges,37.27% of total billed charges,307.48,37.27,,245.98,percent of total billed charges,37.27% of total billed charges,307.48,37.27,,245.98,percent of total billed charges,37.27% of total billed charges,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,507.31,145,,,fee schedule,145% of CMS fee schedule,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330,40,,264,percent of total billed charges,40% of total billed charges,258.79,660,
EKG,7650005,CDM,730,RC,93005,HCPCS,Outpatient,,,112,89.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,8.15,145,,,fee schedule,145% of CMS fee schedule,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,40,,35.84,percent of total billed charges,40% of total billed charges,8.15,89.6,
EEG CEREBRAL DEATH E,7650005,CDM,730,RC,95824,HCPCS,Outpatient,,,848,678.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,678.4,80,,542.72,percent of total billed charges,80% of total billed charges,316.05,37.27,,252.84,percent of total billed charges,37.27% of total billed charges,316.05,37.27,,252.84,percent of total billed charges,37.27% of total billed charges,316.05,37.27,,252.84,percent of total billed charges,37.27% of total billed charges,441.92,100,,,fee schedule,100% of APC rate,441.92,100,,,fee schedule,100% of APC rate,441.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,441.92,100,,,fee schedule,100% of APC rate,441.92,100,,,fee schedule,100% of APC rate,441.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,339.2,40,,271.36,percent of total billed charges,40% of total billed charges,316.05,678.4,
TREADMILL,7650062,CDM,482,RC,93017,HCPCS,Outpatient,,,561,448.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% of total billed charges,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,48.02,145,,,fee schedule,145% of CMS fee schedule,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.4,40,,179.52,percent of total billed charges,40% of total billed charges,48.02,448.8,
HOLTER RECORDING,7650120,CDM,731,RC,93225,HCPCS,Outpatient,,,382,305.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,305.6,80,,244.48,percent of total billed charges,80% of total billed charges,142.37,37.27,,113.9,percent of total billed charges,37.27% of total billed charges,142.37,37.27,,113.9,percent of total billed charges,37.27% of total billed charges,142.37,37.27,,113.9,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,23.37,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152.8,40,,122.24,percent of total billed charges,40% of total billed charges,23.37,305.6,
EEG AWAKE/DROWSEY,7612344,CDM,740,RC,95816,HCPCS,Outpatient,,,765,612.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,612,80,,489.6,percent of total billed charges,80% of total billed charges,285.12,37.27,,228.1,percent of total billed charges,37.27% of total billed charges,285.12,37.27,,228.1,percent of total billed charges,37.27% of total billed charges,285.12,37.27,,228.1,percent of total billed charges,37.27% of total billed charges,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,431.07,145,,,fee schedule,145% of CMS fee schedule,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,306,40,,244.8,percent of total billed charges,40% of total billed charges,258.79,612,
ICU OBV PER HR,8399990,CDM,762,RC,G0378,HCPCS,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% 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,34,40,,27.2,percent of total billed charges,40% of total billed charges,31.68,68,
DELIVERY,8411001,CDM,722,RC,,,Outpatient,,,2400,1920.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1920,80,,1536,percent of total billed charges,80% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% 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,960,40,,768,percent of total billed charges,40% of total billed charges,894.48,1920,
DELIVERY W LEVEL 1-2,8411001,CDM,722,RC,,,Outpatient,,,2543,2034.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2034.4,80,,1627.52,percent of total billed charges,80% of total billed charges,947.78,37.27,,758.22,percent of total billed charges,37.27% of total billed charges,947.78,37.27,,758.22,percent of total billed charges,37.27% of total billed charges,947.78,37.27,,758.22,percent of total billed charges,37.27% 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,1017.2,40,,813.76,percent of total billed charges,40% of total billed charges,947.78,2034.4,
CURRETTE,5645742,CDM,270,RC,,,Outpatient,,,45,36.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% 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,18,40,,14.4,percent of total billed charges,40% of total billed charges,16.77,36,
EPIDURAL,5612346,CDM,761,RC,SURG,HCPCS,Outpatient,,,1396,1116.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1116.8,80,,893.44,percent of total billed charges,80% of total billed charges,520.29,37.27,,416.23,percent of total billed charges,37.27% of total billed charges,520.29,37.27,,416.23,percent of total billed charges,37.27% of total billed charges,520.29,37.27,,416.23,percent of total billed charges,37.27% 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,558.4,40,,446.72,percent of total billed charges,40% of total billed charges,520.29,1116.8,
OB OBV PER HR,8399990,CDM,762,RC,G0378,HCPCS,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% 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,34,40,,27.2,percent of total billed charges,40% of total billed charges,31.68,68,
OAE HEARING SCRN MON,6739411,CDM,470,RC,92587,HCPCS,Outpatient,,,547,437.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,203.87,37.27,,163.1,percent of total billed charges,37.27% of total billed charges,203.87,37.27,,163.1,percent of total billed charges,37.27% of total billed charges,203.87,37.27,,163.1,percent of total billed charges,37.27% of total billed charges,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,4.77,145,,,fee schedule,145% of CMS fee schedule,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,218.8,40,,175.04,percent of total billed charges,40% of total billed charges,4.77,437.6,
SNARE COLON,5801832,CDM,272,RC,,,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% 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,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,14.54,31.2,
FORCEPS PRECISOR HOT,5801832,CDM,272,RC,,,Outpatient,,,22,17.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% 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,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,8.2,17.6,
MASTISOL,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
PULSAVAC IM TIP,5645742,CDM,270,RC,,,Outpatient,,,47,37.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% 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,18.8,40,,15.04,percent of total billed charges,40% of total billed charges,17.52,37.6,
PULSAVAC IM BRUSH TI,5645742,CDM,270,RC,,,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% 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,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,27.58,59.2,
PULSAVAC FAN SPRAY T,5645742,CDM,270,RC,,,Outpatient,,,41,32.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% 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,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,15.28,32.8,
PULSAVAC HAND CONTRO,5645742,CDM,270,RC,,,Outpatient,,,94,75.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% 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,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,35.03,75.2,
TOURNIQUET CUFF,5645742,CDM,270,RC,,,Outpatient,,,107,85.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,39.88,37.27,,31.9,percent of total billed charges,37.27% of total billed charges,39.88,37.27,,31.9,percent of total billed charges,37.27% of total billed charges,39.88,37.27,,31.9,percent of total billed charges,37.27% 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,42.8,40,,34.24,percent of total billed charges,40% of total billed charges,39.88,85.6,
BRONCH BX FORCEPS,5801832,CDM,272,RC,,,Outpatient,,,145,116.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116,80,,92.8,percent of total billed charges,80% of total billed charges,54.04,37.27,,43.23,percent of total billed charges,37.27% of total billed charges,54.04,37.27,,43.23,percent of total billed charges,37.27% of total billed charges,54.04,37.27,,43.23,percent of total billed charges,37.27% 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,58,40,,46.4,percent of total billed charges,40% of total billed charges,54.04,116,
OXILAN,5645742,CDM,270,RC,,,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% 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,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,14.54,31.2,
TVT VAGINAL TAPE,8605396,CDM,278,RC,C1771,HCPCS,Outpatient,,,1826,1460.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1460.8,80,,1168.64,percent of total billed charges,80% of total billed charges,680.55,37.27,,544.44,percent of total billed charges,37.27% of total billed charges,680.55,37.27,,544.44,percent of total billed charges,37.27% of total billed charges,680.55,37.27,,544.44,percent of total billed charges,37.27% 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,730.4,40,,584.32,percent of total billed charges,40% of total billed charges,680.55,1460.8,
TRANSGASTRIC JEJUNAL,5645742,CDM,270,RC,,,Outpatient,,,398,318.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% 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,159.2,40,,127.36,percent of total billed charges,40% of total billed charges,148.33,318.4,
GASTROSTOMY KIT MCKY,5801832,CDM,272,RC,,,Outpatient,,,194,155.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.2,80,,124.16,percent of total billed charges,80% of total billed charges,72.3,37.27,,57.84,percent of total billed charges,37.27% of total billed charges,72.3,37.27,,57.84,percent of total billed charges,37.27% of total billed charges,72.3,37.27,,57.84,percent of total billed charges,37.27% 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,77.6,40,,62.08,percent of total billed charges,40% of total billed charges,72.3,155.2,
BLADE STRYKER SAW,5801832,CDM,272,RC,,,Outpatient,,,90,72.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% 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,36,40,,28.8,percent of total billed charges,40% of total billed charges,33.54,72,
SUCTION POLYP TRAP,5645742,CDM,270,RC,,,Outpatient,,,36,28.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% 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,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,13.42,28.8,
INTRAOPERATIVE KNEE,5645742,CDM,270,RC,,,Outpatient,,,231.75,185.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,185.4,80,,148.32,percent of total billed charges,80% of total billed charges,86.37,37.27,,69.1,percent of total billed charges,37.27% of total billed charges,86.37,37.27,,69.1,percent of total billed charges,37.27% of total billed charges,86.37,37.27,,69.1,percent of total billed charges,37.27% 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,92.7,40,,74.16,percent of total billed charges,40% of total billed charges,86.37,185.4,
IMHS SCREW HIP LT,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2497,1997.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1997.6,80,,1598.08,percent of total billed charges,80% of total billed charges,930.63,37.27,,744.5,percent of total billed charges,37.27% of total billed charges,930.63,37.27,,744.5,percent of total billed charges,37.27% of total billed charges,930.63,37.27,,744.5,percent of total billed charges,37.27% 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,998.8,40,,799.04,percent of total billed charges,40% of total billed charges,930.63,1997.6,
SNARE MINI,5801832,CDM,272,RC,,,Outpatient,,,90,72.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% 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,36,40,,28.8,percent of total billed charges,40% of total billed charges,33.54,72,
IMHS CALIBRATED TWIS,5645742,CDM,270,RC,,,Outpatient,,,113,90.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% 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,45.2,40,,36.16,percent of total billed charges,40% of total billed charges,42.12,90.4,
DISPOSABLE CLIP,5645742,CDM,270,RC,,,Outpatient,,,119,95.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% 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,47.6,40,,38.08,percent of total billed charges,40% of total billed charges,44.35,95.2,
GEL PORT,5645742,CDM,270,RC,,,Outpatient,,,1500,1200.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1200,80,,960,percent of total billed charges,80% of total billed charges,559.05,37.27,,447.24,percent of total billed charges,37.27% of total billed charges,559.05,37.27,,447.24,percent of total billed charges,37.27% of total billed charges,559.05,37.27,,447.24,percent of total billed charges,37.27% 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,600,40,,480,percent of total billed charges,40% of total billed charges,559.05,1200,
SPOT INK,5645742,CDM,270,RC,,,Outpatient,,,80,64.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% 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,32,40,,25.6,percent of total billed charges,40% of total billed charges,29.82,64,
DIAL-A-FLO,5645742,CDM,270,RC,,,Outpatient,,,35,28.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28,80,,22.4,percent of total billed charges,80% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% 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,14,40,,11.2,percent of total billed charges,40% of total billed charges,13.04,28,
ERCP PEG 24 BAL REPL,5645742,CDM,270,RC,,,Outpatient,,,348,278.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% 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,139.2,40,,111.36,percent of total billed charges,40% of total billed charges,129.7,278.4,
ELASTIC STAYS 5MM,5645742,CDM,270,RC,,,Outpatient,,,15.2,12.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,80,,9.73,percent of total billed charges,80% of total billed charges,5.67,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.67,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.67,37.27,,4.54,percent of total billed charges,37.27% 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,6.08,40,,4.86,percent of total billed charges,40% of total billed charges,5.67,12.16,
TROCAR 11MM,5801832,CDM,272,RC,,,Outpatient,,,186,148.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% 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,74.4,40,,59.52,percent of total billed charges,40% of total billed charges,69.32,148.8,
TROCAR 5MM,5801832,CDM,272,RC,,,Outpatient,,,255,204.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204,80,,163.2,percent of total billed charges,80% of total billed charges,95.04,37.27,,76.03,percent of total billed charges,37.27% of total billed charges,95.04,37.27,,76.03,percent of total billed charges,37.27% of total billed charges,95.04,37.27,,76.03,percent of total billed charges,37.27% 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,102,40,,81.6,percent of total billed charges,40% of total billed charges,95.04,204,
PROBE SIDE FIRE,5645742,CDM,270,RC,,,Outpatient,,,398,318.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% 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,159.2,40,,127.36,percent of total billed charges,40% of total billed charges,148.33,318.4,
DVT COMPRSN PUMP SLV,5645742,CDM,270,RC,,,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% 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,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,27.21,58.4,
O2 MASK/TUBING,5645742,CDM,270,RC,,,Outpatient,,,29,23.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% 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,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,10.81,23.2,
PLASTER TAPE J&J,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
IMMOBILIZER KNEE,5645742,CDM,270,RC,,,Outpatient,,,58,46.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% 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,23.2,40,,18.56,percent of total billed charges,40% of total billed charges,21.62,46.4,
STOCKINETTE DELTA NT,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
ELECTRODE ROLLER BAL,5645742,CDM,270,RC,,,Outpatient,,,186,148.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% 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,74.4,40,,59.52,percent of total billed charges,40% of total billed charges,69.32,148.8,
CANNULA VESSEL IRRIG,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
NASAL JEJUNAL FEEDIN,5645742,CDM,270,RC,,,Outpatient,,,153,122.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,57.02,37.27,,45.62,percent of total billed charges,37.27% of total billed charges,57.02,37.27,,45.62,percent of total billed charges,37.27% of total billed charges,57.02,37.27,,45.62,percent of total billed charges,37.27% 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,61.2,40,,48.96,percent of total billed charges,40% of total billed charges,57.02,122.4,
ARTHO PUMP DISP,5645742,CDM,270,RC,,,Outpatient,,,102,81.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% 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,40.8,40,,32.64,percent of total billed charges,40% of total billed charges,38.02,81.6,
LAP LIGACLIP EN 10MM,5801832,CDM,272,RC,,,Outpatient,,,403.92,323.14,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,323.14,80,,258.51,percent of total billed charges,80% of total billed charges,150.54,37.27,,120.43,percent of total billed charges,37.27% of total billed charges,150.54,37.27,,120.43,percent of total billed charges,37.27% of total billed charges,150.54,37.27,,120.43,percent of total billed charges,37.27% 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,161.57,40,,129.26,percent of total billed charges,40% of total billed charges,150.54,323.14,
STRYKER PAIN 2-DAY I,5801832,CDM,272,RC,A4305,HCPCS,Outpatient,,,482,385.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,385.6,80,,308.48,percent of total billed charges,80% of total billed charges,179.64,37.27,,143.71,percent of total billed charges,37.27% of total billed charges,179.64,37.27,,143.71,percent of total billed charges,37.27% of total billed charges,179.64,37.27,,143.71,percent of total billed charges,37.27% 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,192.8,40,,154.24,percent of total billed charges,40% of total billed charges,179.64,385.6,
STAPLER SKIN CONCORD,5801832,CDM,272,RC,,,Outpatient,,,117,93.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,43.61,37.27,,34.89,percent of total billed charges,37.27% of total billed charges,43.61,37.27,,34.89,percent of total billed charges,37.27% of total billed charges,43.61,37.27,,34.89,percent of total billed charges,37.27% 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,46.8,40,,37.44,percent of total billed charges,40% of total billed charges,43.61,93.6,
IRIS RETRACTOR FLEX,5801832,CDM,272,RC,,,Outpatient,,,116,92.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% 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,46.4,40,,37.12,percent of total billed charges,40% of total billed charges,43.23,92.8,
MESH KUGEL 8 X 10,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,3264,2611.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2611.2,80,,2088.96,percent of total billed charges,80% of total billed charges,1216.49,37.27,,973.19,percent of total billed charges,37.27% of total billed charges,1216.49,37.27,,973.19,percent of total billed charges,37.27% of total billed charges,1216.49,37.27,,973.19,percent of total billed charges,37.27% 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,1305.6,40,,1044.48,percent of total billed charges,40% of total billed charges,1216.49,2611.2,
MESH KUGEL 10 X 13,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,4080,3264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3264,80,,2611.2,percent of total billed charges,80% of total billed charges,1520.62,37.27,,1216.5,percent of total billed charges,37.27% of total billed charges,1520.62,37.27,,1216.5,percent of total billed charges,37.27% of total billed charges,1520.62,37.27,,1216.5,percent of total billed charges,37.27% 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,1632,40,,1305.6,percent of total billed charges,40% of total billed charges,1520.62,3264,
J-VAC RESORVOIR 450,5645742,CDM,270,RC,,,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% 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,34,40,,27.2,percent of total billed charges,40% of total billed charges,31.68,68,
VITRECTOMY TUBING SE,5645742,CDM,270,RC,,,Outpatient,,,256,204.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.8,80,,163.84,percent of total billed charges,80% of total billed charges,95.41,37.27,,76.33,percent of total billed charges,37.27% of total billed charges,95.41,37.27,,76.33,percent of total billed charges,37.27% of total billed charges,95.41,37.27,,76.33,percent of total billed charges,37.27% 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,102.4,40,,81.92,percent of total billed charges,40% of total billed charges,95.41,204.8,
DRAIN JACKSON PRATT,5645742,CDM,270,RC,,,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% 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,44,40,,35.2,percent of total billed charges,40% of total billed charges,41,88,
FEMORAL WICKS,5645742,CDM,270,RC,,,Outpatient,,,86,68.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,32.05,37.27,,25.64,percent of total billed charges,37.27% of total billed charges,32.05,37.27,,25.64,percent of total billed charges,37.27% of total billed charges,32.05,37.27,,25.64,percent of total billed charges,37.27% 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,34.4,40,,27.52,percent of total billed charges,40% of total billed charges,32.05,68.8,
STERIS 20 STERILANT,5801832,CDM,272,RC,,,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
FORCEPS BIOPSY HOT,5801832,CDM,272,RC,,,Outpatient,,,107,85.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,39.88,37.27,,31.9,percent of total billed charges,37.27% of total billed charges,39.88,37.27,,31.9,percent of total billed charges,37.27% of total billed charges,39.88,37.27,,31.9,percent of total billed charges,37.27% 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,42.8,40,,34.24,percent of total billed charges,40% of total billed charges,39.88,85.6,
INFUSE A PORT 7 FR V,8605396,CDM,278,RC,C1788,HCPCS,Outpatient,,,584,467.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,467.2,80,,373.76,percent of total billed charges,80% of total billed charges,217.66,37.27,,174.13,percent of total billed charges,37.27% of total billed charges,217.66,37.27,,174.13,percent of total billed charges,37.27% of total billed charges,217.66,37.27,,174.13,percent of total billed charges,37.27% 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,233.6,40,,186.88,percent of total billed charges,40% of total billed charges,217.66,467.2,
ERCP BRUSH CYTOLOGY,5801832,CDM,272,RC,,,Outpatient,,,233,186.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186.4,80,,149.12,percent of total billed charges,80% of total billed charges,86.84,37.27,,69.47,percent of total billed charges,37.27% of total billed charges,86.84,37.27,,69.47,percent of total billed charges,37.27% of total billed charges,86.84,37.27,,69.47,percent of total billed charges,37.27% 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,93.2,40,,74.56,percent of total billed charges,40% of total billed charges,86.84,186.4,
PEG J TUBE 12-24,5645742,CDM,270,RC,,,Outpatient,,,326,260.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260.8,80,,208.64,percent of total billed charges,80% of total billed charges,121.5,37.27,,97.2,percent of total billed charges,37.27% of total billed charges,121.5,37.27,,97.2,percent of total billed charges,37.27% of total billed charges,121.5,37.27,,97.2,percent of total billed charges,37.27% 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,130.4,40,,104.32,percent of total billed charges,40% of total billed charges,121.5,260.8,
ERCP BALLOON STN EXT,5801832,CDM,272,RC,,,Outpatient,,,240,192.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192,80,,153.6,percent of total billed charges,80% of total billed charges,89.45,37.27,,71.56,percent of total billed charges,37.27% of total billed charges,89.45,37.27,,71.56,percent of total billed charges,37.27% of total billed charges,89.45,37.27,,71.56,percent of total billed charges,37.27% 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,96,40,,76.8,percent of total billed charges,40% of total billed charges,89.45,192,
PRESSURE INFUSER DSP,5645742,CDM,270,RC,,,Outpatient,,,108,86.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% 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,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,40.25,86.4,
T-TUBE GOODE VENT,5645742,CDM,270,RC,,,Outpatient,,,171,136.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,63.73,37.27,,50.98,percent of total billed charges,37.27% of total billed charges,63.73,37.27,,50.98,percent of total billed charges,37.27% of total billed charges,63.73,37.27,,50.98,percent of total billed charges,37.27% 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,68.4,40,,54.72,percent of total billed charges,40% of total billed charges,63.73,136.8,
HERNIA PATCH KUGEL S,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,1795,1436.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1436,80,,1148.8,percent of total billed charges,80% of total billed charges,669,37.27,,535.2,percent of total billed charges,37.27% of total billed charges,669,37.27,,535.2,percent of total billed charges,37.27% of total billed charges,669,37.27,,535.2,percent of total billed charges,37.27% 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,718,40,,574.4,percent of total billed charges,40% of total billed charges,669,1436,
HERNIA PATCH KUGEL S,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,1408,1126.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1126.4,80,,901.12,percent of total billed charges,80% of total billed charges,524.76,37.27,,419.81,percent of total billed charges,37.27% of total billed charges,524.76,37.27,,419.81,percent of total billed charges,37.27% of total billed charges,524.76,37.27,,419.81,percent of total billed charges,37.27% 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,563.2,40,,450.56,percent of total billed charges,40% of total billed charges,524.76,1126.4,
HERNIA PATCH KUGEL L,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,3366,2692.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2692.8,80,,2154.24,percent of total billed charges,80% of total billed charges,1254.51,37.27,,1003.61,percent of total billed charges,37.27% of total billed charges,1254.51,37.27,,1003.61,percent of total billed charges,37.27% of total billed charges,1254.51,37.27,,1003.61,percent of total billed charges,37.27% 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,1346.4,40,,1077.12,percent of total billed charges,40% of total billed charges,1254.51,2692.8,
HERNIA PATCH KUGEL L,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,2040,1632.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1632,80,,1305.6,percent of total billed charges,80% of total billed charges,760.31,37.27,,608.25,percent of total billed charges,37.27% of total billed charges,760.31,37.27,,608.25,percent of total billed charges,37.27% of total billed charges,760.31,37.27,,608.25,percent of total billed charges,37.27% 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,816,40,,652.8,percent of total billed charges,40% of total billed charges,760.31,1632,
HERNIA PATCH KUGEL M,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,2652,2121.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2121.6,80,,1697.28,percent of total billed charges,80% of total billed charges,988.4,37.27,,790.72,percent of total billed charges,37.27% of total billed charges,988.4,37.27,,790.72,percent of total billed charges,37.27% of total billed charges,988.4,37.27,,790.72,percent of total billed charges,37.27% 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,1060.8,40,,848.64,percent of total billed charges,40% of total billed charges,988.4,2121.6,
IMHS SCREW HIP,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1060,848.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,848,80,,678.4,percent of total billed charges,80% of total billed charges,395.06,37.27,,316.05,percent of total billed charges,37.27% of total billed charges,395.06,37.27,,316.05,percent of total billed charges,37.27% of total billed charges,395.06,37.27,,316.05,percent of total billed charges,37.27% 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,424,40,,339.2,percent of total billed charges,40% of total billed charges,395.06,848,
SLING ARM CH-ADT-LG,5645742,CDM,270,RC,,,Outpatient,,,29,23.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% 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,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,10.81,23.2,
LIGATOR MULTIBAND SI,5801832,CDM,272,RC,,,Outpatient,,,377,301.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,301.6,80,,241.28,percent of total billed charges,80% of total billed charges,140.51,37.27,,112.41,percent of total billed charges,37.27% of total billed charges,140.51,37.27,,112.41,percent of total billed charges,37.27% of total billed charges,140.51,37.27,,112.41,percent of total billed charges,37.27% 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,150.8,40,,120.64,percent of total billed charges,40% of total billed charges,140.51,301.6,
STOCKINETTE IMPRVIOS,5645742,CDM,270,RC,,,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% 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,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,18.26,39.2,
MECONIUM ASPIRATOR,5645742,CDM,270,RC,,,Outpatient,,,34,27.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% 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,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,12.67,27.2,
NEEDLE WANG ASP TRAN,5801832,CDM,272,RC,,,Outpatient,,,167,133.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.6,80,,106.88,percent of total billed charges,80% of total billed charges,62.24,37.27,,49.79,percent of total billed charges,37.27% of total billed charges,62.24,37.27,,49.79,percent of total billed charges,37.27% of total billed charges,62.24,37.27,,49.79,percent of total billed charges,37.27% 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,66.8,40,,53.44,percent of total billed charges,40% of total billed charges,62.24,133.6,
IMHS CENTERING SLEEV,8605396,CDM,278,RC,,,Outpatient,,,234,187.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.2,80,,149.76,percent of total billed charges,80% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% 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,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,87.21,187.2,
IMHS SET SCREWS,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,145,116.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116,80,,92.8,percent of total billed charges,80% of total billed charges,54.04,37.27,,43.23,percent of total billed charges,37.27% of total billed charges,54.04,37.27,,43.23,percent of total billed charges,37.27% of total billed charges,54.04,37.27,,43.23,percent of total billed charges,37.27% 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,58,40,,46.4,percent of total billed charges,40% of total billed charges,54.04,116,
IMHS COMP SCREW,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,81,64.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% 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,32.4,40,,25.92,percent of total billed charges,40% of total billed charges,30.19,64.8,
IMHS BONE SCREW,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,44,35.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% 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,17.6,40,,14.08,percent of total billed charges,40% of total billed charges,16.4,35.2,
IMHS LAG SCREW,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,315,252.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252,80,,201.6,percent of total billed charges,80% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% 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,126,40,,100.8,percent of total billed charges,40% of total billed charges,117.4,252,
NEEDLE SCLEROTHERAPY,5801832,CDM,272,RC,,,Outpatient,,,113,90.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% 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,45.2,40,,36.16,percent of total billed charges,40% of total billed charges,42.12,90.4,
BANDAGE ESMARK,5645742,CDM,270,RC,,,Outpatient,,,16,12.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% 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,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,5.96,12.8,
PHACO CASSETTE/TUBIN,5645742,CDM,270,RC,,,Outpatient,,,37,29.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% 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,14.8,40,,11.84,percent of total billed charges,40% of total billed charges,13.79,29.6,
PHACOSERT CARTRIDGE,5645742,CDM,270,RC,,,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
BOVIE LEEP TIP ALL S,5645742,CDM,270,RC,,,Outpatient,,,115,92.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% 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,46,40,,36.8,percent of total billed charges,40% of total billed charges,42.86,92,
FASCIA LATA 2X7 CM,8605396,CDM,278,RC,,,Outpatient,,,1000,800.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,800,80,,640,percent of total billed charges,80% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% 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,400,40,,320,percent of total billed charges,40% of total billed charges,372.7,800,
RX BIL STENT 10/5,5801832,CDM,272,RC,C2625,HCPCS,Outpatient,,,239,191.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% 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,95.6,40,,76.48,percent of total billed charges,40% of total billed charges,89.08,191.2,
RX BIL STENT 7/10,5801832,CDM,272,RC,C2625,HCPCS,Outpatient,,,239,191.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% 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,95.6,40,,76.48,percent of total billed charges,40% of total billed charges,89.08,191.2,
RX RETRIVAL BALLOON,5801832,CDM,272,RC,C1773,HCPCS,Outpatient,,,304,243.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.2,80,,194.56,percent of total billed charges,80% of total billed charges,113.3,37.27,,90.64,percent of total billed charges,37.27% of total billed charges,113.3,37.27,,90.64,percent of total billed charges,37.27% of total billed charges,113.3,37.27,,90.64,percent of total billed charges,37.27% 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,121.6,40,,97.28,percent of total billed charges,40% of total billed charges,113.3,243.2,
RX TRPZD RTRVL BASKT,5801832,CDM,272,RC,,,Outpatient,,,435,348.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,348,80,,278.4,percent of total billed charges,80% of total billed charges,162.12,37.27,,129.7,percent of total billed charges,37.27% of total billed charges,162.12,37.27,,129.7,percent of total billed charges,37.27% of total billed charges,162.12,37.27,,129.7,percent of total billed charges,37.27% 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,174,40,,139.2,percent of total billed charges,40% of total billed charges,162.12,348,
RX AUTOTOME 20ML,5801832,CDM,272,RC,,,Outpatient,,,406,324.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,324.8,80,,259.84,percent of total billed charges,80% of total billed charges,151.32,37.27,,121.06,percent of total billed charges,37.27% of total billed charges,151.32,37.27,,121.06,percent of total billed charges,37.27% of total billed charges,151.32,37.27,,121.06,percent of total billed charges,37.27% 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,162.4,40,,129.92,percent of total billed charges,40% of total billed charges,151.32,324.8,
JAGWIRE .025,5801832,CDM,272,RC,C1769,HCPCS,Outpatient,,,305,244.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244,80,,195.2,percent of total billed charges,80% of total billed charges,113.67,37.27,,90.94,percent of total billed charges,37.27% of total billed charges,113.67,37.27,,90.94,percent of total billed charges,37.27% of total billed charges,113.67,37.27,,90.94,percent of total billed charges,37.27% 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,122,40,,97.6,percent of total billed charges,40% of total billed charges,113.67,244,
RAPID REFILL INJECTI,5645742,CDM,270,RC,,,Outpatient,,,90,72.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% 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,36,40,,28.8,percent of total billed charges,40% of total billed charges,33.54,72,
RX LOCKING DEVICE,5645742,CDM,270,RC,,,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% 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,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,18.26,39.2,
RX NEEDLEKNIFE,5645742,CDM,270,RC,,,Outpatient,,,406,324.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,324.8,80,,259.84,percent of total billed charges,80% of total billed charges,151.32,37.27,,121.06,percent of total billed charges,37.27% of total billed charges,151.32,37.27,,121.06,percent of total billed charges,37.27% of total billed charges,151.32,37.27,,121.06,percent of total billed charges,37.27% 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,162.4,40,,129.92,percent of total billed charges,40% of total billed charges,151.32,324.8,
RX CYTOLOGY BRUSH,5801832,CDM,272,RC,,,Outpatient,,,228,182.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,182.4,80,,145.92,percent of total billed charges,80% of total billed charges,84.98,37.27,,67.98,percent of total billed charges,37.27% of total billed charges,84.98,37.27,,67.98,percent of total billed charges,37.27% of total billed charges,84.98,37.27,,67.98,percent of total billed charges,37.27% 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,91.2,40,,72.96,percent of total billed charges,40% of total billed charges,84.98,182.4,
RX BIL STENT 7/7,5801832,CDM,272,RC,C2625,HCPCS,Outpatient,,,220,176.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176,80,,140.8,percent of total billed charges,80% of total billed charges,81.99,37.27,,65.59,percent of total billed charges,37.27% of total billed charges,81.99,37.27,,65.59,percent of total billed charges,37.27% of total billed charges,81.99,37.27,,65.59,percent of total billed charges,37.27% 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,88,40,,70.4,percent of total billed charges,40% of total billed charges,81.99,176,
CANCELLOUS CHIPS 30C,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,694,555.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,555.2,80,,444.16,percent of total billed charges,80% of total billed charges,258.65,37.27,,206.92,percent of total billed charges,37.27% of total billed charges,258.65,37.27,,206.92,percent of total billed charges,37.27% of total billed charges,258.65,37.27,,206.92,percent of total billed charges,37.27% 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,277.6,40,,222.08,percent of total billed charges,40% of total billed charges,258.65,555.2,
HERNIA PATCH KUGEL O,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,940,752.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,752,80,,601.6,percent of total billed charges,80% of total billed charges,350.34,37.27,,280.27,percent of total billed charges,37.27% of total billed charges,350.34,37.27,,280.27,percent of total billed charges,37.27% of total billed charges,350.34,37.27,,280.27,percent of total billed charges,37.27% 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,376,40,,300.8,percent of total billed charges,40% of total billed charges,350.34,752,
RX BIL STENT 7/15,5801832,CDM,272,RC,C2625,HCPCS,Outpatient,,,220,176.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176,80,,140.8,percent of total billed charges,80% of total billed charges,81.99,37.27,,65.59,percent of total billed charges,37.27% of total billed charges,81.99,37.27,,65.59,percent of total billed charges,37.27% of total billed charges,81.99,37.27,,65.59,percent of total billed charges,37.27% 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,88,40,,70.4,percent of total billed charges,40% of total billed charges,81.99,176,
HERNIA PATCH KUGEL O,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,1124,899.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,899.2,80,,719.36,percent of total billed charges,80% of total billed charges,418.91,37.27,,335.13,percent of total billed charges,37.27% of total billed charges,418.91,37.27,,335.13,percent of total billed charges,37.27% of total billed charges,418.91,37.27,,335.13,percent of total billed charges,37.27% 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,449.6,40,,359.68,percent of total billed charges,40% of total billed charges,418.91,899.2,
BLADE GENERAL,5801832,CDM,272,RC,,,Outpatient,,,196,156.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% 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,78.4,40,,62.72,percent of total billed charges,40% of total billed charges,73.05,156.8,
BLADE TOTAL KNEE,5801832,CDM,272,RC,,,Outpatient,,,565,452.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,452,80,,361.6,percent of total billed charges,80% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% 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,226,40,,180.8,percent of total billed charges,40% of total billed charges,210.58,452,
AMBI PLATES STD,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,574,459.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,459.2,80,,367.36,percent of total billed charges,80% of total billed charges,213.93,37.27,,171.14,percent of total billed charges,37.27% of total billed charges,213.93,37.27,,171.14,percent of total billed charges,37.27% of total billed charges,213.93,37.27,,171.14,percent of total billed charges,37.27% 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,229.6,40,,183.68,percent of total billed charges,40% of total billed charges,213.93,459.2,
AMBI CLIP,5645742,CDM,270,RC,,,Outpatient,,,104,83.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.2,80,,66.56,percent of total billed charges,80% of total billed charges,38.76,37.27,,31.01,percent of total billed charges,37.27% of total billed charges,38.76,37.27,,31.01,percent of total billed charges,37.27% of total billed charges,38.76,37.27,,31.01,percent of total billed charges,37.27% 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,41.6,40,,33.28,percent of total billed charges,40% of total billed charges,38.76,83.2,
GUIDE PINS ALL SZ,8605396,CDM,278,RC,,,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% 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,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,62.4,
FORCEPS BIOPSY COLD,5801832,CDM,272,RC,,,Outpatient,,,61,48.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% 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,24.4,40,,19.52,percent of total billed charges,40% of total billed charges,22.73,48.8,
RX BIL STENT 4CM,5801832,CDM,272,RC,C1874,HCPCS,Outpatient,,,3264,2611.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2611.2,80,,2088.96,percent of total billed charges,80% of total billed charges,1216.49,37.27,,973.19,percent of total billed charges,37.27% of total billed charges,1216.49,37.27,,973.19,percent of total billed charges,37.27% of total billed charges,1216.49,37.27,,973.19,percent of total billed charges,37.27% 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,1305.6,40,,1044.48,percent of total billed charges,40% of total billed charges,1216.49,2611.2,
RX BIL STENT 6CM,5801832,CDM,272,RC,C1874,HCPCS,Outpatient,,,3264,2611.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2611.2,80,,2088.96,percent of total billed charges,80% of total billed charges,1216.49,37.27,,973.19,percent of total billed charges,37.27% of total billed charges,1216.49,37.27,,973.19,percent of total billed charges,37.27% of total billed charges,1216.49,37.27,,973.19,percent of total billed charges,37.27% 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,1305.6,40,,1044.48,percent of total billed charges,40% of total billed charges,1216.49,2611.2,
BANDAGE ACE 4X11 STE,5645742,CDM,270,RC,,,Outpatient,,,37,29.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% 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,14.8,40,,11.84,percent of total billed charges,40% of total billed charges,13.79,29.6,
PIN STEIN,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% 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,44,40,,35.2,percent of total billed charges,40% of total billed charges,41,88,
SCREW CANCELLOUS 4.0,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,106,84.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% 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,42.4,40,,33.92,percent of total billed charges,40% of total billed charges,39.51,84.8,
WASHER,8605396,CDM,278,RC,,,Outpatient,,,44,35.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% 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,17.6,40,,14.08,percent of total billed charges,40% of total billed charges,16.4,35.2,
SCREW CANNULATED,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,294,235.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.2,80,,188.16,percent of total billed charges,80% of total billed charges,109.57,37.27,,87.66,percent of total billed charges,37.27% of total billed charges,109.57,37.27,,87.66,percent of total billed charges,37.27% of total billed charges,109.57,37.27,,87.66,percent of total billed charges,37.27% 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,117.6,40,,94.08,percent of total billed charges,40% of total billed charges,109.57,235.2,
AMBU BAG CHILD,5645742,CDM,270,RC,,,Outpatient,,,81,64.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% 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,32.4,40,,25.92,percent of total billed charges,40% of total billed charges,30.19,64.8,
AMBU BAG INFANT,5645742,CDM,270,RC,,,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% 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,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,62.4,
VALVE SUCTION OLYMPU,5645742,CDM,270,RC,,,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% 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,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,8.94,19.2,
VALVE BIOPSY OLYMPUS,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
BANDAGE ACE 6X11 STE,5645742,CDM,270,RC,,,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% 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,28,40,,22.4,percent of total billed charges,40% of total billed charges,26.09,56,
SPLINT ALUMAFOAM,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
MESHER SKIN CARRIER,5801832,CDM,272,RC,,,Outpatient,,,58,46.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% 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,23.2,40,,18.56,percent of total billed charges,40% of total billed charges,21.62,46.4,
BANDING LIGATING KIT,5645742,CDM,270,RC,,,Outpatient,,,648,518.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,518.4,80,,414.72,percent of total billed charges,80% of total billed charges,241.51,37.27,,193.21,percent of total billed charges,37.27% of total billed charges,241.51,37.27,,193.21,percent of total billed charges,37.27% of total billed charges,241.51,37.27,,193.21,percent of total billed charges,37.27% 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,259.2,40,,207.36,percent of total billed charges,40% of total billed charges,241.51,518.4,
FOGARY CATH-ALL,5801832,CDM,272,RC,C1757,HCPCS,Outpatient,,,156,124.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% 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,62.4,40,,49.92,percent of total billed charges,40% of total billed charges,58.14,124.8,
BILE BAG,5645742,CDM,270,RC,,,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% 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,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,14.54,31.2,
BIOPSY TRAY JAMSHIDI,5801832,CDM,272,RC,,,Outpatient,,,77,61.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% 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,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,28.7,61.6,
BLADE BEAVER,5801832,CDM,272,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
ARTHRO BLADE ALL SZ,5801832,CDM,272,RC,,,Outpatient,,,152,121.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,56.65,37.27,,45.32,percent of total billed charges,37.27% of total billed charges,56.65,37.27,,45.32,percent of total billed charges,37.27% of total billed charges,56.65,37.27,,45.32,percent of total billed charges,37.27% 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,60.8,40,,48.64,percent of total billed charges,40% of total billed charges,56.65,121.6,
BONE GRAFT COLLAGRAF,8605396,CDM,278,RC,,,Outpatient,,,1408,1126.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1126.4,80,,901.12,percent of total billed charges,80% of total billed charges,524.76,37.27,,419.81,percent of total billed charges,37.27% of total billed charges,524.76,37.27,,419.81,percent of total billed charges,37.27% of total billed charges,524.76,37.27,,419.81,percent of total billed charges,37.27% 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,563.2,40,,450.56,percent of total billed charges,40% of total billed charges,524.76,1126.4,
BRONC SPEC TRAP,5645742,CDM,270,RC,,,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
BRUSH CYTOLOGY BRONC,5801832,CDM,272,RC,,,Outpatient,,,45,36.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% 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,18,40,,14.4,percent of total billed charges,40% of total billed charges,16.77,36,
KERLIX BULKY BANDAGE,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
LAP SURGINEEDLE 150,5801832,CDM,272,RC,,,Outpatient,,,89,71.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,33.17,37.27,,26.54,percent of total billed charges,37.27% of total billed charges,33.17,37.27,,26.54,percent of total billed charges,37.27% of total billed charges,33.17,37.27,,26.54,percent of total billed charges,37.27% 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,35.6,40,,28.48,percent of total billed charges,40% of total billed charges,33.17,71.2,
PLASTER SPLINT,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
LACRYMAL CANNULA CUR,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
SHUNT CAROTID BYPASS,5801832,CDM,272,RC,,,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% 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,34,40,,27.2,percent of total billed charges,40% of total billed charges,31.68,68,
CAST DELTA LITE 5X30,5645742,CDM,270,RC,,,Outpatient,,,46,36.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% 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,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,17.14,36.8,
CAST TAPE SCOTCH,5645742,CDM,270,RC,,,Outpatient,,,40,32.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% 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,16,40,,12.8,percent of total billed charges,40% of total billed charges,14.91,32,
CATH CHOLANGIOGRAM O,5801832,CDM,272,RC,,,Outpatient,,,60,48.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% 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,24,40,,19.2,percent of total billed charges,40% of total billed charges,22.36,48,
LAP CHOLE CATHETER,5801832,CDM,272,RC,,,Outpatient,,,288,230.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230.4,80,,184.32,percent of total billed charges,80% of total billed charges,107.34,37.27,,85.87,percent of total billed charges,37.27% of total billed charges,107.34,37.27,,85.87,percent of total billed charges,37.27% of total billed charges,107.34,37.27,,85.87,percent of total billed charges,37.27% 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,115.2,40,,92.16,percent of total billed charges,40% of total billed charges,107.34,230.4,
CATH CONE TIP,5801832,CDM,272,RC,,,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% 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,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,18.26,39.2,
CATH FOLEY 24W/30CC,5801832,CDM,272,RC,,,Outpatient,,,93,74.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% 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,37.2,40,,29.76,percent of total billed charges,40% of total billed charges,34.66,74.4,
CATH IRRIGATION,5801832,CDM,272,RC,,,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% 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,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,27.21,58.4,
CATH MALECOT,5801832,CDM,272,RC,,,Outpatient,,,42,33.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% 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,16.8,40,,13.44,percent of total billed charges,40% of total billed charges,15.65,33.6,
CATH MUSHROOM,5801832,CDM,272,RC,,,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% 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,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,14.54,31.2,
CATH OLIVE TIP,5801832,CDM,272,RC,,,Outpatient,,,93,74.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% 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,37.2,40,,29.76,percent of total billed charges,40% of total billed charges,34.66,74.4,
CATH ROUND TIP,5801832,CDM,272,RC,,,Outpatient,,,93,74.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% 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,37.2,40,,29.76,percent of total billed charges,40% of total billed charges,34.66,74.4,
CATH SPIRAL TIP,5801832,CDM,272,RC,,,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% 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,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,27.21,58.4,
CATH WHISTLE TIP 4FR,5801832,CDM,272,RC,,,Outpatient,,,93,74.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% 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,37.2,40,,29.76,percent of total billed charges,40% of total billed charges,34.66,74.4,
CATH WHISTLE TIP 6FR,5801832,CDM,272,RC,,,Outpatient,,,174,139.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,64.85,37.27,,51.88,percent of total billed charges,37.27% of total billed charges,64.85,37.27,,51.88,percent of total billed charges,37.27% of total billed charges,64.85,37.27,,51.88,percent of total billed charges,37.27% 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,69.6,40,,55.68,percent of total billed charges,40% of total billed charges,64.85,139.2,
CATH FOLEY W INFLTR,5801832,CDM,272,RC,,,Outpatient,,,41,32.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% 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,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,15.28,32.8,
CEMENT BONE ZIMMER,8605396,CDM,278,RC,,,Outpatient,,,411.76,329.41,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,329.41,80,,263.53,percent of total billed charges,80% of total billed charges,153.46,37.27,,122.77,percent of total billed charges,37.27% of total billed charges,153.46,37.27,,122.77,percent of total billed charges,37.27% of total billed charges,153.46,37.27,,122.77,percent of total billed charges,37.27% 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,164.7,40,,131.76,percent of total billed charges,40% of total billed charges,153.46,329.41,
LAP LIGACLIP EN 5MM,5801832,CDM,272,RC,,,Outpatient,,,471.57,377.26,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,377.26,80,,301.81,percent of total billed charges,80% of total billed charges,175.75,37.27,,140.6,percent of total billed charges,37.27% of total billed charges,175.75,37.27,,140.6,percent of total billed charges,37.27% of total billed charges,175.75,37.27,,140.6,percent of total billed charges,37.27% 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,188.63,40,,150.9,percent of total billed charges,40% of total billed charges,175.75,377.26,
CEMENT PRESSIRIZER D,5645742,CDM,270,RC,,,Outpatient,,,114,91.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,42.49,37.27,,33.99,percent of total billed charges,37.27% of total billed charges,42.49,37.27,,33.99,percent of total billed charges,37.27% of total billed charges,42.49,37.27,,33.99,percent of total billed charges,37.27% 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,45.6,40,,36.48,percent of total billed charges,40% of total billed charges,42.49,91.2,
BERKELY COLLECTION B,5645742,CDM,270,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
BERKELY COLL SET DIS,5645742,CDM,270,RC,,,Outpatient,,,36,28.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% 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,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,13.42,28.8,
MESH PERFIX PLUG XLG,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,745,596.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,596,80,,476.8,percent of total billed charges,80% of total billed charges,277.66,37.27,,222.13,percent of total billed charges,37.27% of total billed charges,277.66,37.27,,222.13,percent of total billed charges,37.27% of total billed charges,277.66,37.27,,222.13,percent of total billed charges,37.27% 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,298,40,,238.4,percent of total billed charges,40% of total billed charges,277.66,596,
CEMENT MIXER DISP,5801832,CDM,272,RC,,,Outpatient,,,241,192.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,89.82,37.27,,71.86,percent of total billed charges,37.27% of total billed charges,89.82,37.27,,71.86,percent of total billed charges,37.27% of total billed charges,89.82,37.27,,71.86,percent of total billed charges,37.27% 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,96.4,40,,77.12,percent of total billed charges,40% of total billed charges,89.82,192.8,
HOLLISTER CORD CLAMP,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
BOVIE CORD E0503 DIS,5645742,CDM,270,RC,,,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% 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,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,10.06,21.6,
LAP TUBING FILT CO2,5645742,CDM,270,RC,,,Outpatient,,,93,74.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% 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,37.2,40,,29.76,percent of total billed charges,40% of total billed charges,34.66,74.4,
BONE PLUG UNIVERSAL,8605396,CDM,278,RC,,,Outpatient,,,324,259.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,259.2,80,,207.36,percent of total billed charges,80% of total billed charges,120.75,37.27,,96.6,percent of total billed charges,37.27% of total billed charges,120.75,37.27,,96.6,percent of total billed charges,37.27% of total billed charges,120.75,37.27,,96.6,percent of total billed charges,37.27% 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,129.6,40,,103.68,percent of total billed charges,40% of total billed charges,120.75,259.2,
BONE PLUG (SM),8605396,CDM,278,RC,,,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% 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,64,40,,51.2,percent of total billed charges,40% of total billed charges,59.63,128,
BERKELY CURETTE VAC,5645742,CDM,270,RC,,,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% 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,10,40,,8,percent of total billed charges,40% of total billed charges,9.32,20,
NEEDLE CYSTOTOME IRR,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
DRAPE IOBAN STERI 66,5645742,CDM,270,RC,,,Outpatient,,,119,95.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% 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,47.6,40,,38.08,percent of total billed charges,40% of total billed charges,44.35,95.2,
DISTILLED WATER POUR,5645742,CDM,270,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
DRAIN SPONGE,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
PEG REPLCMNT 14-20FR,5645742,CDM,270,RC,,,Outpatient,,,107,85.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.6,80,,68.48,percent of total billed charges,80% of total billed charges,39.88,37.27,,31.9,percent of total billed charges,37.27% of total billed charges,39.88,37.27,,31.9,percent of total billed charges,37.27% of total billed charges,39.88,37.27,,31.9,percent of total billed charges,37.27% 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,42.8,40,,34.24,percent of total billed charges,40% of total billed charges,39.88,85.6,
DRAPE IOBAN-2 LARGE,5645742,CDM,270,RC,,,Outpatient,,,67.1,53.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.68,80,,42.94,percent of total billed charges,80% of total billed charges,25.01,37.27,,20.01,percent of total billed charges,37.27% of total billed charges,25.01,37.27,,20.01,percent of total billed charges,37.27% of total billed charges,25.01,37.27,,20.01,percent of total billed charges,37.27% 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,26.84,40,,21.47,percent of total billed charges,40% of total billed charges,25.01,53.68,
DRAPE IOBAN-2 SMALL,5645742,CDM,270,RC,,,Outpatient,,,32.5,26.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26,80,,20.8,percent of total billed charges,80% of total billed charges,12.11,37.27,,9.69,percent of total billed charges,37.27% of total billed charges,12.11,37.27,,9.69,percent of total billed charges,37.27% of total billed charges,12.11,37.27,,9.69,percent of total billed charges,37.27% 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,13,40,,10.4,percent of total billed charges,40% of total billed charges,12.11,26,
DRAPE HAND,5645742,CDM,270,RC,,,Outpatient,,,115.25,92.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.2,80,,73.76,percent of total billed charges,80% of total billed charges,42.95,37.27,,34.36,percent of total billed charges,37.27% of total billed charges,42.95,37.27,,34.36,percent of total billed charges,37.27% of total billed charges,42.95,37.27,,34.36,percent of total billed charges,37.27% 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,46.1,40,,36.88,percent of total billed charges,40% of total billed charges,42.95,92.2,
DRAPE UNDERBUTTOCKS,5645742,CDM,270,RC,,,Outpatient,,,50.9,40.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.72,80,,32.58,percent of total billed charges,80% of total billed charges,18.97,37.27,,15.18,percent of total billed charges,37.27% of total billed charges,18.97,37.27,,15.18,percent of total billed charges,37.27% of total billed charges,18.97,37.27,,15.18,percent of total billed charges,37.27% 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,20.36,40,,16.29,percent of total billed charges,40% of total billed charges,18.97,40.72,
C-ARM COVER,5645742,CDM,270,RC,,,Outpatient,,,39.3,31.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.44,80,,25.15,percent of total billed charges,80% of total billed charges,14.65,37.27,,11.72,percent of total billed charges,37.27% of total billed charges,14.65,37.27,,11.72,percent of total billed charges,37.27% of total billed charges,14.65,37.27,,11.72,percent of total billed charges,37.27% 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,15.72,40,,12.58,percent of total billed charges,40% of total billed charges,14.65,31.44,
DRAPE SPLIT SHEET BL,5645742,CDM,270,RC,,,Outpatient,,,32.7,26.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.16,80,,20.93,percent of total billed charges,80% of total billed charges,12.19,37.27,,9.75,percent of total billed charges,37.27% of total billed charges,12.19,37.27,,9.75,percent of total billed charges,37.27% of total billed charges,12.19,37.27,,9.75,percent of total billed charges,37.27% 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,13.08,40,,10.46,percent of total billed charges,40% of total billed charges,12.19,26.16,
ECLCTRODE QUICK COMB,5645742,CDM,270,RC,,,Outpatient,,,62,49.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% 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,24.8,40,,19.84,percent of total billed charges,40% of total billed charges,23.11,49.6,
BOVIE SUC COAG HANDS,5645742,CDM,270,RC,,,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% 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,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,14.54,31.2,
BOVIE EXTENSION VL-E,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
BOVIE SUC COAGULATOR,5645742,CDM,270,RC,,,Outpatient,,,42,33.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% 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,16.8,40,,13.44,percent of total billed charges,40% of total billed charges,15.65,33.6,
BOVIE NEEDLE VL-E-15,5801832,CDM,272,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
BOVIE PAD VL-E-7507,5645742,CDM,270,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
BOVIE PENCIL VL-2515,5645742,CDM,270,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
LAP ENDOCATCH,5801832,CDM,272,RC,,,Outpatient,,,235,188.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188,80,,150.4,percent of total billed charges,80% of total billed charges,87.58,37.27,,70.06,percent of total billed charges,37.27% of total billed charges,87.58,37.27,,70.06,percent of total billed charges,37.27% of total billed charges,87.58,37.27,,70.06,percent of total billed charges,37.27% 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,94,40,,75.2,percent of total billed charges,40% of total billed charges,87.58,188,
DERMABOND SKIN ADHES,5801832,CDM,272,RC,,,Outpatient,,,113,90.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.4,80,,72.32,percent of total billed charges,80% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% of total billed charges,42.12,37.27,,33.7,percent of total billed charges,37.27% 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,45.2,40,,36.16,percent of total billed charges,40% of total billed charges,42.12,90.4,
EXTENSION SET IV,5645742,CDM,270,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
EYE PATCH PIRATE,5645742,CDM,270,RC,,,Outpatient,,,4,3.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
EYE SHIELD METAL,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
LAP MEGA POUCH,5801832,CDM,272,RC,,,Outpatient,,,115,92.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% 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,46,40,,36.8,percent of total billed charges,40% of total billed charges,42.86,92,
FOGARY SAFEJAW INSET,5645742,CDM,270,RC,,,Outpatient,,,82,65.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,30.56,37.27,,24.45,percent of total billed charges,37.27% of total billed charges,30.56,37.27,,24.45,percent of total billed charges,37.27% of total billed charges,30.56,37.27,,24.45,percent of total billed charges,37.27% 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,32.8,40,,26.24,percent of total billed charges,40% of total billed charges,30.56,65.6,
PEG FLEX 18FR,5645742,CDM,270,RC,,,Outpatient,,,365,292.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,292,80,,233.6,percent of total billed charges,80% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% 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,146,40,,116.8,percent of total billed charges,40% of total billed charges,136.04,292,
PEG 24 PULL,5645742,CDM,270,RC,,,Outpatient,,,289,231.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,107.71,37.27,,86.17,percent of total billed charges,37.27% of total billed charges,107.71,37.27,,86.17,percent of total billed charges,37.27% of total billed charges,107.71,37.27,,86.17,percent of total billed charges,37.27% 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,115.6,40,,92.48,percent of total billed charges,40% of total billed charges,107.71,231.2,
BLADE GIGLI SAW,5801832,CDM,272,RC,,,Outpatient,,,38,30.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.4,80,,24.32,percent of total billed charges,80% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% of total billed charges,14.16,37.27,,11.33,percent of total billed charges,37.27% 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,15.2,40,,12.16,percent of total billed charges,40% of total billed charges,14.16,30.4,
MITEX ANCHORS GII,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,311,248.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,248.8,80,,199.04,percent of total billed charges,80% of total billed charges,115.91,37.27,,92.73,percent of total billed charges,37.27% of total billed charges,115.91,37.27,,92.73,percent of total billed charges,37.27% of total billed charges,115.91,37.27,,92.73,percent of total billed charges,37.27% 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,124.4,40,,99.52,percent of total billed charges,40% of total billed charges,115.91,248.8,
MESH MARLEX MED,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,226,180.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,84.23,37.27,,67.38,percent of total billed charges,37.27% of total billed charges,84.23,37.27,,67.38,percent of total billed charges,37.27% of total billed charges,84.23,37.27,,67.38,percent of total billed charges,37.27% 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,90.4,40,,72.32,percent of total billed charges,40% of total billed charges,84.23,180.8,
GUIDEWIRE ALL SIZE,5801832,CDM,272,RC,C1769,HCPCS,Outpatient,,,95,76.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% 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,38,40,,30.4,percent of total billed charges,40% of total billed charges,35.41,76,
GREENFIELD FILTER,8605396,CDM,278,RC,C1880,HCPCS,Outpatient,,,2297,1837.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1837.6,80,,1470.08,percent of total billed charges,80% of total billed charges,856.09,37.27,,684.87,percent of total billed charges,37.27% of total billed charges,856.09,37.27,,684.87,percent of total billed charges,37.27% of total billed charges,856.09,37.27,,684.87,percent of total billed charges,37.27% 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,918.8,40,,735.04,percent of total billed charges,40% of total billed charges,856.09,1837.6,
BLANKET BAIR FULL BO,5645742,CDM,270,RC,,,Outpatient,,,29,23.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% 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,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,10.81,23.2,
MESH MARLEX PRE SHAP,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,212,169.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,169.6,80,,135.68,percent of total billed charges,80% of total billed charges,79.01,37.27,,63.21,percent of total billed charges,37.27% of total billed charges,79.01,37.27,,63.21,percent of total billed charges,37.27% of total billed charges,79.01,37.27,,63.21,percent of total billed charges,37.27% 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,84.8,40,,67.84,percent of total billed charges,40% of total billed charges,79.01,169.6,
SYRINGE GAUGE ASM 60,5645742,CDM,270,RC,,,Outpatient,,,77,61.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% 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,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,28.7,61.6,
INFUSE A PORT,8605396,CDM,278,RC,C1788,HCPCS,Outpatient,,,967,773.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,773.6,80,,618.88,percent of total billed charges,80% of total billed charges,360.4,37.27,,288.32,percent of total billed charges,37.27% of total billed charges,360.4,37.27,,288.32,percent of total billed charges,37.27% of total billed charges,360.4,37.27,,288.32,percent of total billed charges,37.27% 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,386.8,40,,309.44,percent of total billed charges,40% of total billed charges,360.4,773.6,
ESOPH BALLOON DL CTH,5801832,CDM,272,RC,C1726,HCPCS,Outpatient,,,398,318.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% 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,159.2,40,,127.36,percent of total billed charges,40% of total billed charges,148.33,318.4,
INTERCEED,8605396,CDM,278,RC,C1765,HCPCS,Outpatient,,,261,208.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208.8,80,,167.04,percent of total billed charges,80% of total billed charges,97.27,37.27,,77.82,percent of total billed charges,37.27% of total billed charges,97.27,37.27,,77.82,percent of total billed charges,37.27% of total billed charges,97.27,37.27,,77.82,percent of total billed charges,37.27% 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,104.4,40,,83.52,percent of total billed charges,40% of total billed charges,97.27,208.8,
COLD THERAPY PAD,5645742,CDM,270,RC,,,Outpatient,,,115,92.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% 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,46,40,,36.8,percent of total billed charges,40% of total billed charges,42.86,92,
IRR SOD CHL 3000CC 0,5645742,CDM,270,RC,,,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% 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,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,10.06,21.6,
ERCP ESOPHAGEAL BAL,5801832,CDM,272,RC,,,Outpatient,,,257,205.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,205.6,80,,164.48,percent of total billed charges,80% of total billed charges,95.78,37.27,,76.62,percent of total billed charges,37.27% of total billed charges,95.78,37.27,,76.62,percent of total billed charges,37.27% of total billed charges,95.78,37.27,,76.62,percent of total billed charges,37.27% 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,102.8,40,,82.24,percent of total billed charges,40% of total billed charges,95.78,205.6,
DRAIN JVAC ROUND FLU,5645742,CDM,270,RC,,,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% 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,34,40,,27.2,percent of total billed charges,40% of total billed charges,31.68,68,
DRAIN J-VAC RESER 15,5645742,CDM,270,RC,,,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% 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,34,40,,27.2,percent of total billed charges,40% of total billed charges,31.68,68,
JURGAN PIN BALL,5645742,CDM,270,RC,,,Outpatient,,,23,18.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% 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,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,8.57,18.4,
K WIRE 451-006,5645742,CDM,270,RC,C1713,HCPCS,Outpatient,,,133,106.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% 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,53.2,40,,42.56,percent of total billed charges,40% of total billed charges,49.57,106.4,
Y-TYPE BLOOD SOL SET,5645742,CDM,270,RC,,,Outpatient,,,21,16.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% 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,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,7.83,16.8,
SUCTION TIP YANKAUER,5645742,CDM,270,RC,,,Outpatient,,,4,3.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
DERMATOME BLADE ZIMM,5801832,CDM,272,RC,,,Outpatient,,,83,66.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% 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,33.2,40,,26.56,percent of total billed charges,40% of total billed charges,30.93,66.4,
CLO TEST CT-20,5645742,CDM,270,RC,,,Outpatient,,,35,28.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28,80,,22.4,percent of total billed charges,80% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% 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,14,40,,11.2,percent of total billed charges,40% of total billed charges,13.04,28,
BLANKET BAIR ALL SZS,5645742,CDM,270,RC,,,Outpatient,,,67,53.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% 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,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,24.97,53.6,
PEG 28 BRT BALLOON R,5645742,CDM,270,RC,,,Outpatient,,,94,75.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% 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,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,35.03,75.2,
ENDO CLO-TEST HELICO,5801832,CDM,272,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
VESSEL LOOPS,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
02 NASAL CANN,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
ENDO BAG PARACENTESI,5645742,CDM,270,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
SUTURE MULTIPLE PACK,5801832,CDM,272,RC,,,Outpatient,,,41,32.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% 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,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,15.28,32.8,
SUTURE TIES,5801832,CDM,272,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
SUTURE EYES,5801832,CDM,272,RC,,,Outpatient,,,66,52.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% 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,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,24.6,52.8,
SUTURE CARDIO VASCUL,5801832,CDM,272,RC,,,Outpatient,,,45,36.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% 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,18,40,,14.4,percent of total billed charges,40% of total billed charges,16.77,36,
ENDO RETRIEVAL BASCK,5801832,CDM,272,RC,,,Outpatient,,,116,92.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% 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,46.4,40,,37.12,percent of total billed charges,40% of total billed charges,43.23,92.8,
LACRIMAL INTUBATION,5645742,CDM,270,RC,,,Outpatient,,,146,116.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% 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,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,54.41,116.8,
SPONGE LAP DISP,5645742,CDM,270,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
LAP PEANUT DISSECTOR,5801832,CDM,272,RC,,,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% 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,28,40,,22.4,percent of total billed charges,40% of total billed charges,26.09,56,
LAP SURGIWAND,5801832,CDM,272,RC,,,Outpatient,,,159,127.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.2,80,,101.76,percent of total billed charges,80% of total billed charges,59.26,37.27,,47.41,percent of total billed charges,37.27% of total billed charges,59.26,37.27,,47.41,percent of total billed charges,37.27% of total billed charges,59.26,37.27,,47.41,percent of total billed charges,37.27% 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,63.6,40,,50.88,percent of total billed charges,40% of total billed charges,59.26,127.2,
MOUTHPIECE E-Z GUARD,5645742,CDM,270,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
NAIL RUSH INTR 3/16,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,165,132.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% 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,66,40,,52.8,percent of total billed charges,40% of total billed charges,61.5,132,
NEEDLE BIOPSY TRUCUT,5801832,CDM,272,RC,,,Outpatient,,,59,47.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,80,,37.76,percent of total billed charges,80% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% of total billed charges,21.99,37.27,,17.59,percent of total billed charges,37.27% 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,23.6,40,,18.88,percent of total billed charges,40% of total billed charges,21.99,47.2,
NUGAUZE IDFOAM 1/4-1,5645742,CDM,270,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
OP SITE ALL SZ,5645742,CDM,270,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
PARACENTESIS TRAY,5645742,CDM,270,RC,,,Outpatient,,,122,97.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% 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,48.8,40,,39.04,percent of total billed charges,40% of total billed charges,45.47,97.6,
PEN SKIN MARKER DEVO,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
PENROSE DRAIN STRL,5645742,CDM,270,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
PERITONEAL LAVAGE AR,5645742,CDM,270,RC,,,Outpatient,,,131,104.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% 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,52.4,40,,41.92,percent of total billed charges,40% of total billed charges,48.82,104.8,
PLATE BUTTRESS/CONDY,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,771,616.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,616.8,80,,493.44,percent of total billed charges,80% of total billed charges,287.35,37.27,,229.88,percent of total billed charges,37.27% of total billed charges,287.35,37.27,,229.88,percent of total billed charges,37.27% of total billed charges,287.35,37.27,,229.88,percent of total billed charges,37.27% 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,308.4,40,,246.72,percent of total billed charges,40% of total billed charges,287.35,616.8,
PLATE CLOVERLEAF,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,335,268.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268,80,,214.4,percent of total billed charges,80% of total billed charges,124.85,37.27,,99.88,percent of total billed charges,37.27% of total billed charges,124.85,37.27,,99.88,percent of total billed charges,37.27% of total billed charges,124.85,37.27,,99.88,percent of total billed charges,37.27% 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,134,40,,107.2,percent of total billed charges,40% of total billed charges,124.85,268,
PLATE DCP,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,298,238.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,238.4,80,,190.72,percent of total billed charges,80% of total billed charges,111.06,37.27,,88.85,percent of total billed charges,37.27% of total billed charges,111.06,37.27,,88.85,percent of total billed charges,37.27% of total billed charges,111.06,37.27,,88.85,percent of total billed charges,37.27% 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,119.2,40,,95.36,percent of total billed charges,40% of total billed charges,111.06,238.4,
PLATE MINI,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,177,141.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,141.6,80,,113.28,percent of total billed charges,80% of total billed charges,65.97,37.27,,52.78,percent of total billed charges,37.27% of total billed charges,65.97,37.27,,52.78,percent of total billed charges,37.27% of total billed charges,65.97,37.27,,52.78,percent of total billed charges,37.27% 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,70.8,40,,56.64,percent of total billed charges,40% of total billed charges,65.97,141.6,
PLATE T,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,362,289.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.6,80,,231.68,percent of total billed charges,80% of total billed charges,134.92,37.27,,107.94,percent of total billed charges,37.27% of total billed charges,134.92,37.27,,107.94,percent of total billed charges,37.27% of total billed charges,134.92,37.27,,107.94,percent of total billed charges,37.27% 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,144.8,40,,115.84,percent of total billed charges,40% of total billed charges,134.92,289.6,
PLATE TUBULAR,8605396,CDM,278,RC,,,Outpatient,,,138,110.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.4,80,,88.32,percent of total billed charges,80% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% 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,55.2,40,,44.16,percent of total billed charges,40% of total billed charges,51.43,110.4,
ADAPTOR PROTEX SWIVE,5645742,CDM,270,RC,,,Outpatient,,,27.85,22.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.28,80,,17.82,percent of total billed charges,80% of total billed charges,10.38,37.27,,8.3,percent of total billed charges,37.27% of total billed charges,10.38,37.27,,8.3,percent of total billed charges,37.27% of total billed charges,10.38,37.27,,8.3,percent of total billed charges,37.27% 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,11.14,40,,8.91,percent of total billed charges,40% of total billed charges,10.38,22.28,
RETRIEVAL BASKET F.O,5801832,CDM,272,RC,,,Outpatient,,,116,92.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% 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,46.4,40,,37.12,percent of total billed charges,40% of total billed charges,43.23,92.8,
PROBE ABC FLEXIBLE 3,5645742,CDM,270,RC,,,Outpatient,,,386,308.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308.8,80,,247.04,percent of total billed charges,80% of total billed charges,143.86,37.27,,115.09,percent of total billed charges,37.27% of total billed charges,143.86,37.27,,115.09,percent of total billed charges,37.27% of total billed charges,143.86,37.27,,115.09,percent of total billed charges,37.27% 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,154.4,40,,123.52,percent of total billed charges,40% of total billed charges,143.86,308.8,
ERBE ELECTRODE PAD,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
CLIP RANEY SCALP,5645742,CDM,270,RC,,,Outpatient,,,21,16.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% 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,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,7.83,16.8,
SUTURE SINGLE PACK,5801832,CDM,272,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
SALEM SUMP TUBE,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
SCREW CANCELLOUS 6.5,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,93,74.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% 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,37.2,40,,29.76,percent of total billed charges,40% of total billed charges,34.66,74.4,
SCREW CORTEX,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,42,33.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% 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,16.8,40,,13.44,percent of total billed charges,40% of total billed charges,15.65,33.6,
SIGMOIDOSCOPE SUCTIO,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
SIGMOIDOSCOPE DISP,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
SIGMOIDOSCOPE FLEXIB,5645742,CDM,270,RC,,,Outpatient,,,208,166.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,77.52,37.27,,62.02,percent of total billed charges,37.27% of total billed charges,77.52,37.27,,62.02,percent of total billed charges,37.27% of total billed charges,77.52,37.27,,62.02,percent of total billed charges,37.27% 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,83.2,40,,66.56,percent of total billed charges,40% of total billed charges,77.52,166.4,
STRYKER AUTO TRANSFU,5645742,CDM,270,RC,,,Outpatient,,,373,298.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,298.4,80,,238.72,percent of total billed charges,80% of total billed charges,139.02,37.27,,111.22,percent of total billed charges,37.27% of total billed charges,139.02,37.27,,111.22,percent of total billed charges,37.27% of total billed charges,139.02,37.27,,111.22,percent of total billed charges,37.27% 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,149.2,40,,119.36,percent of total billed charges,40% of total billed charges,139.02,298.4,
BSS 500CC,5645742,CDM,270,RC,,,Outpatient,,,29,23.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% 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,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,10.81,23.2,
PRO OPTIC STICK,5645742,CDM,270,RC,,,Outpatient,,,29,23.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% 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,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,10.81,23.2,
STOMA MEASURING DEV,5645742,CDM,270,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
DRESSING SPONGE,5801832,CDM,272,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
SUTURE AUTO GIA 80 M,5645742,CDM,270,RC,,,Outpatient,,,646,516.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% 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,258.4,40,,206.72,percent of total billed charges,40% of total billed charges,240.76,516.8,
SUTURE AUTO GIA 80 D,5645742,CDM,270,RC,,,Outpatient,,,338,270.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,270.4,80,,216.32,percent of total billed charges,80% of total billed charges,125.97,37.27,,100.78,percent of total billed charges,37.27% of total billed charges,125.97,37.27,,100.78,percent of total billed charges,37.27% of total billed charges,125.97,37.27,,100.78,percent of total billed charges,37.27% 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,135.2,40,,108.16,percent of total billed charges,40% of total billed charges,125.97,270.4,
KNIFE MICRO,5645742,CDM,270,RC,,,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% 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,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,10.06,21.6,
SUCTION CANNISTER LG,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
SUCTION CANNISTER XL,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
SUCTION TUBING 1/4X1,5645742,CDM,270,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
SUCTION FRAZIER TIP,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
DRESSING SURG OWENS,5801832,CDM,272,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
SURGICEL 2X3,5645742,CDM,270,RC,,,Outpatient,,,97,77.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% 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,38.8,40,,31.04,percent of total billed charges,40% of total billed charges,36.15,77.6,
SUTURE AUTO SURGICLI,5645742,CDM,270,RC,,,Outpatient,,,199,159.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% 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,79.6,40,,63.68,percent of total billed charges,40% of total billed charges,74.17,159.2,
TROCAR 5/12,5801832,CDM,272,RC,,,Outpatient,,,218,174.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% 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,87.2,40,,69.76,percent of total billed charges,40% of total billed charges,81.25,174.4,
SUTURE AUTO EEA 25 C,5645742,CDM,270,RC,,,Outpatient,,,1219,975.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,975.2,80,,780.16,percent of total billed charges,80% of total billed charges,454.32,37.27,,363.46,percent of total billed charges,37.27% of total billed charges,454.32,37.27,,363.46,percent of total billed charges,37.27% of total billed charges,454.32,37.27,,363.46,percent of total billed charges,37.27% 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,487.6,40,,390.08,percent of total billed charges,40% of total billed charges,454.32,975.2,
SUTURE AUTO EEA 28 C,5645742,CDM,270,RC,,,Outpatient,,,706,564.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,564.8,80,,451.84,percent of total billed charges,80% of total billed charges,263.13,37.27,,210.5,percent of total billed charges,37.27% of total billed charges,263.13,37.27,,210.5,percent of total billed charges,37.27% of total billed charges,263.13,37.27,,210.5,percent of total billed charges,37.27% 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,282.4,40,,225.92,percent of total billed charges,40% of total billed charges,263.13,564.8,
SUTURE AUTO EEA 31 C,5645742,CDM,270,RC,,,Outpatient,,,559,447.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,447.2,80,,357.76,percent of total billed charges,80% of total billed charges,208.34,37.27,,166.67,percent of total billed charges,37.27% of total billed charges,208.34,37.27,,166.67,percent of total billed charges,37.27% of total billed charges,208.34,37.27,,166.67,percent of total billed charges,37.27% 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,223.6,40,,178.88,percent of total billed charges,40% of total billed charges,208.34,447.2,
LAP ENDOLOOP EL21L,5801832,CDM,272,RC,,,Outpatient,,,87,69.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% 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,34.8,40,,27.84,percent of total billed charges,40% of total billed charges,32.42,69.6,
SUTURE AUTO GIA 60 D,5645742,CDM,270,RC,,,Outpatient,,,312,249.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% 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,124.8,40,,99.84,percent of total billed charges,40% of total billed charges,116.28,249.6,
SUTURE AUTO GIA 60 M,5645742,CDM,270,RC,,,Outpatient,,,338,270.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,270.4,80,,216.32,percent of total billed charges,80% of total billed charges,125.97,37.27,,100.78,percent of total billed charges,37.27% of total billed charges,125.97,37.27,,100.78,percent of total billed charges,37.27% of total billed charges,125.97,37.27,,100.78,percent of total billed charges,37.27% 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,135.2,40,,108.16,percent of total billed charges,40% of total billed charges,125.97,270.4,
SUTURE AUTO TA60 4.8,5645742,CDM,270,RC,,,Outpatient,,,119,95.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% 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,47.6,40,,38.08,percent of total billed charges,40% of total billed charges,44.35,95.2,
SUTURE AUTO SURGICLI,5645742,CDM,270,RC,,,Outpatient,,,247,197.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,197.6,80,,158.08,percent of total billed charges,80% of total billed charges,92.06,37.27,,73.65,percent of total billed charges,37.27% of total billed charges,92.06,37.27,,73.65,percent of total billed charges,37.27% of total billed charges,92.06,37.27,,73.65,percent of total billed charges,37.27% 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,98.8,40,,79.04,percent of total billed charges,40% of total billed charges,92.06,197.6,
SUTURE AUTO TA 60 3.,5645742,CDM,270,RC,,,Outpatient,,,251,200.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.8,80,,160.64,percent of total billed charges,80% of total billed charges,93.55,37.27,,74.84,percent of total billed charges,37.27% of total billed charges,93.55,37.27,,74.84,percent of total billed charges,37.27% of total billed charges,93.55,37.27,,74.84,percent of total billed charges,37.27% 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,100.4,40,,80.32,percent of total billed charges,40% of total billed charges,93.55,200.8,
SUTURE AUTO TA 60 3.,5645742,CDM,270,RC,,,Outpatient,,,369,295.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,137.53,37.27,,110.02,percent of total billed charges,37.27% of total billed charges,137.53,37.27,,110.02,percent of total billed charges,37.27% of total billed charges,137.53,37.27,,110.02,percent of total billed charges,37.27% 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,147.6,40,,118.08,percent of total billed charges,40% of total billed charges,137.53,295.2,
SUTURE AUTO TA 60 4.,5645742,CDM,270,RC,,,Outpatient,,,369,295.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,295.2,80,,236.16,percent of total billed charges,80% of total billed charges,137.53,37.27,,110.02,percent of total billed charges,37.27% of total billed charges,137.53,37.27,,110.02,percent of total billed charges,37.27% of total billed charges,137.53,37.27,,110.02,percent of total billed charges,37.27% 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,147.6,40,,118.08,percent of total billed charges,40% of total billed charges,137.53,295.2,
LAP SURGINEEDLE 120,5801832,CDM,272,RC,,,Outpatient,,,99,79.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% 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,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,36.9,79.2,
TUBE T,5645742,CDM,270,RC,,,Outpatient,,,46,36.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% 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,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,17.14,36.8,
TUBE STOMACH EVAC EW,5645742,CDM,270,RC,,,Outpatient,,,106,84.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% 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,42.4,40,,33.92,percent of total billed charges,40% of total billed charges,39.51,84.8,
WIRE-ORTHOPEDIC,5645742,CDM,270,RC,,,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% 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,64,40,,51.2,percent of total billed charges,40% of total billed charges,59.63,128,
EXTERNAL PACEMAKER D,5645742,CDM,270,RC,,,Outpatient,,,31,24.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% 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,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,11.55,24.8,
BERKELY TISSUE TRAP,5645742,CDM,270,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
BIOPSY UTERINE CURET,5801832,CDM,272,RC,,,Outpatient,,,23,18.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% 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,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,8.57,18.4,
TUBE ARMSTRG BEV PL,5645742,CDM,270,RC,,,Outpatient,,,170,136.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136,80,,108.8,percent of total billed charges,80% of total billed charges,63.36,37.27,,50.69,percent of total billed charges,37.27% of total billed charges,63.36,37.27,,50.69,percent of total billed charges,37.27% of total billed charges,63.36,37.27,,50.69,percent of total billed charges,37.27% 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,68,40,,54.4,percent of total billed charges,40% of total billed charges,63.36,136,
TUBE FEEDING INFANT,5645742,CDM,270,RC,,,Outpatient,,,4,3.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
TUBE GAUZE,5645742,CDM,270,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
CONNECTOR TUBING PL,5645742,CDM,270,RC,,,Outpatient,,,162,129.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% 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,64.8,40,,51.84,percent of total billed charges,40% of total billed charges,60.38,129.6,
ARTHRO CONNECT TUBIN,5645742,CDM,270,RC,,,Outpatient,,,106,84.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% 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,42.4,40,,33.92,percent of total billed charges,40% of total billed charges,39.51,84.8,
LAP TUBING PRESSURE,5645742,CDM,270,RC,,,Outpatient,,,21,16.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% 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,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,7.83,16.8,
URETERAL STENT 7X26,5801832,CDM,272,RC,C1758,HCPCS,Outpatient,,,579,463.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,463.2,80,,370.56,percent of total billed charges,80% of total billed charges,215.79,37.27,,172.63,percent of total billed charges,37.27% of total billed charges,215.79,37.27,,172.63,percent of total billed charges,37.27% of total billed charges,215.79,37.27,,172.63,percent of total billed charges,37.27% 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,231.6,40,,185.28,percent of total billed charges,40% of total billed charges,215.79,463.2,
TELE OBV PER HR,8399990,CDM,762,RC,G0378,HCPCS,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% 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,34,40,,27.2,percent of total billed charges,40% of total billed charges,31.68,68,
BLANKET WARM THERMO,5645742,CDM,270,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
NEEDLE BONE MARROW I,5801832,CDM,272,RC,,,Outpatient,,,79,63.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,29.44,37.27,,23.55,percent of total billed charges,37.27% of total billed charges,29.44,37.27,,23.55,percent of total billed charges,37.27% of total billed charges,29.44,37.27,,23.55,percent of total billed charges,37.27% 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,31.6,40,,25.28,percent of total billed charges,40% of total billed charges,29.44,63.2,
CANNU-FLO GUIDE WIRE,5645742,CDM,270,RC,,,Outpatient,,,78,62.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% 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,31.2,40,,24.96,percent of total billed charges,40% of total billed charges,29.07,62.4,
PEDIALYTE,6400014,CDM,250,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
NASAL RAPID RHINO,5645742,CDM,270,RC,,,Outpatient,,,86,68.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,32.05,37.27,,25.64,percent of total billed charges,37.27% of total billed charges,32.05,37.27,,25.64,percent of total billed charges,37.27% of total billed charges,32.05,37.27,,25.64,percent of total billed charges,37.27% 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,34.4,40,,27.52,percent of total billed charges,40% of total billed charges,32.05,68.8,
PLASTER BANDAGE,5645742,CDM,270,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
SOLOSITE GEL TUBE 3,5645742,CDM,270,RC,,,Outpatient,,,35,28.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28,80,,22.4,percent of total billed charges,80% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% of total billed charges,13.04,37.27,,10.43,percent of total billed charges,37.27% 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,14,40,,11.2,percent of total billed charges,40% of total billed charges,13.04,28,
SUTURE J219H,5801832,CDM,272,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
SUTURE G698G,5801832,CDM,272,RC,,,Outpatient,,,30,24.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% 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,12,40,,9.6,percent of total billed charges,40% of total billed charges,11.18,24,
SUTURE SG823/H823H,5801832,CDM,272,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
SUTURE SG1626/1626G,5801832,CDM,272,RC,,,Outpatient,,,21,16.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% 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,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,7.83,16.8,
SUTURE 1668G/SN1668,5801832,CDM,272,RC,,,Outpatient,,,21,16.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% 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,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,7.83,16.8,
SUTURE 5268 61,5801832,CDM,272,RC,,,Outpatient,,,31,24.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% 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,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,11.55,24.8,
SUTURE 7233 41,5801832,CDM,272,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
SUTURE SP1617,5801832,CDM,272,RC,,,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% 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,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,8.94,19.2,
SUTURE SG821,5801832,CDM,272,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
STOCKINETTE SPCIALST,5645742,CDM,270,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
BLADE RING CUTTER,5645742,CDM,270,RC,,,Outpatient,,,51,40.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.8,80,,32.64,percent of total billed charges,80% of total billed charges,19.01,37.27,,15.21,percent of total billed charges,37.27% of total billed charges,19.01,37.27,,15.21,percent of total billed charges,37.27% of total billed charges,19.01,37.27,,15.21,percent of total billed charges,37.27% 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,20.4,40,,16.32,percent of total billed charges,40% of total billed charges,19.01,40.8,
CATH EPISTAXIS,5645742,CDM,270,RC,,,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% 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,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,27.21,58.4,
GUEST FOOD TRAY,6466668,CDM,999,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
MORGAN LENS DELIVERY,5645742,CDM,270,RC,,,Outpatient,,,171,136.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.8,80,,109.44,percent of total billed charges,80% of total billed charges,63.73,37.27,,50.98,percent of total billed charges,37.27% of total billed charges,63.73,37.27,,50.98,percent of total billed charges,37.27% of total billed charges,63.73,37.27,,50.98,percent of total billed charges,37.27% 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,68.4,40,,54.72,percent of total billed charges,40% of total billed charges,63.73,136.8,
COLLAR PHILADELPHIA,5645742,CDM,270,RC,,,Outpatient,,,217,173.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,80.88,37.27,,64.7,percent of total billed charges,37.27% of total billed charges,80.88,37.27,,64.7,percent of total billed charges,37.27% of total billed charges,80.88,37.27,,64.7,percent of total billed charges,37.27% 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,86.8,40,,69.44,percent of total billed charges,40% of total billed charges,80.88,173.6,
SPLINT FINGER,5645742,CDM,270,RC,,,Outpatient,,,22,17.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% 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,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,8.2,17.6,
ELECTRODE EXTERNAL P,5645742,CDM,270,RC,,,Outpatient,,,232,185.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,185.6,80,,148.48,percent of total billed charges,80% of total billed charges,86.47,37.27,,69.18,percent of total billed charges,37.27% of total billed charges,86.47,37.27,,69.18,percent of total billed charges,37.27% of total billed charges,86.47,37.27,,69.18,percent of total billed charges,37.27% 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,92.8,40,,74.24,percent of total billed charges,40% of total billed charges,86.47,185.6,
DRESSING MEPITEL,5801832,CDM,272,RC,,,Outpatient,,,16,12.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% 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,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,5.96,12.8,
ER CARE LVL 1 W PROC,8830002,CDM,450,RC,99281,HCPCS,Outpatient,,,224,179.20,25,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.2,80,,143.36,percent of total billed charges,80% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% of total billed charges,673.2,100,,,case rate ,pays based on per visit rate,673.2,100,,,fee schedule,100% of APC rate,673.2,100,,,fee schedule,100% of APC rate,600,145,,,fee schedule,145% of CMS fee schedule,673.2,100,,,fee schedule,100% of APC rate,673.2,100,,,fee schedule,100% of APC rate,673.2,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,40,,71.68,percent of total billed charges,40% of total billed charges,83.48,673.2,
ER CARE LVL 2 W PROC,8830002,CDM,450,RC,99282,HCPCS,Outpatient,,,365,292.00,25,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,292,80,,233.6,percent of total billed charges,80% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% of total billed charges,734.85,100,,,case rate ,pays based on per visit rate,734.85,100,,,fee schedule,100% of APC rate,734.85,100,,,fee schedule,100% of APC rate,600,145,,,fee schedule,145% of CMS fee schedule,734.85,100,,,fee schedule,100% of APC rate,734.85,100,,,fee schedule,100% of APC rate,734.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146,40,,116.8,percent of total billed charges,40% of total billed charges,136.04,734.85,
ER CARE LVL 3 W PROC,8830002,CDM,450,RC,99283,HCPCS,Outpatient,,,590,472.00,25,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472,80,,377.6,percent of total billed charges,80% of total billed charges,219.89,37.27,,175.91,percent of total billed charges,37.27% of total billed charges,219.89,37.27,,175.91,percent of total billed charges,37.27% of total billed charges,219.89,37.27,,175.91,percent of total billed charges,37.27% of total billed charges,835.24,100,,,case rate ,pays based on per visit rate,835.24,100,,,fee schedule,100% of APC rate,835.24,100,,,fee schedule,100% of APC rate,600,145,,,fee schedule,145% of CMS fee schedule,835.24,100,,,fee schedule,100% of APC rate,835.24,100,,,fee schedule,100% of APC rate,835.24,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236,40,,188.8,percent of total billed charges,40% of total billed charges,219.89,835.24,
ER CARE LVL 4 W PROC,8830002,CDM,450,RC,99284,HCPCS,Outpatient,,,785,628.00,25,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,628,80,,502.4,percent of total billed charges,80% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,965.18,100,,,case rate ,pays based on per visit rate,965.18,100,,,fee schedule,100% of APC rate,965.18,100,,,fee schedule,100% of APC rate,600,145,,,fee schedule,145% of CMS fee schedule,965.18,100,,,fee schedule,100% of APC rate,965.18,100,,,fee schedule,100% of APC rate,965.18,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314,40,,251.2,percent of total billed charges,40% of total billed charges,292.57,965.18,
ER CARE LVL 5 W PROC,8830002,CDM,450,RC,99285,HCPCS,Outpatient,,,1122,897.60,25,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,897.6,80,,718.08,percent of total billed charges,80% of total billed charges,418.17,37.27,,334.54,percent of total billed charges,37.27% of total billed charges,418.17,37.27,,334.54,percent of total billed charges,37.27% of total billed charges,418.17,37.27,,334.54,percent of total billed charges,37.27% of total billed charges,1129.59,100,,,case rate ,pays based on per visit rate,1129.59,100,,,fee schedule,100% of APC rate,1129.59,100,,,fee schedule,100% of APC rate,600,145,,,fee schedule,145% of CMS fee schedule,1129.59,100,,,fee schedule,100% of APC rate,1129.59,100,,,fee schedule,100% of APC rate,1129.59,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,448.8,40,,359.04,percent of total billed charges,40% of total billed charges,418.17,1129.59,
CPR,8830002,CDM,450,RC,92950,HCPCS,Outpatient,,,590,472.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472,80,,377.6,percent of total billed charges,80% of total billed charges,219.89,37.27,,175.91,percent of total billed charges,37.27% of total billed charges,219.89,37.27,,175.91,percent of total billed charges,37.27% of total billed charges,219.89,37.27,,175.91,percent of total billed charges,37.27% of total billed charges,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,257.85,145,,,fee schedule,145% of CMS fee schedule,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236,40,,188.8,percent of total billed charges,40% of total billed charges,219.89,472,
AIR CAST STANDARD,5645742,CDM,270,RC,,,Outpatient,,,102,81.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% 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,40.8,40,,32.64,percent of total billed charges,40% of total billed charges,38.02,81.6,
BRACE ANKLE W/GEL 50,5645742,CDM,270,RC,,,Outpatient,,,89,71.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,33.17,37.27,,26.54,percent of total billed charges,37.27% of total billed charges,33.17,37.27,,26.54,percent of total billed charges,37.27% of total billed charges,33.17,37.27,,26.54,percent of total billed charges,37.27% 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,35.6,40,,28.48,percent of total billed charges,40% of total billed charges,33.17,71.2,
BONE MARROW NEEDLE J,5801832,CDM,272,RC,,,Outpatient,,,93,74.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% 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,37.2,40,,29.76,percent of total billed charges,40% of total billed charges,34.66,74.4,
CATH TROCAR,5645742,CDM,270,RC,,,Outpatient,,,37,29.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% 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,14.8,40,,11.84,percent of total billed charges,40% of total billed charges,13.79,29.6,
SKIN STAPLER DISP,5645742,CDM,270,RC,,,Outpatient,,,86,68.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.8,80,,55.04,percent of total billed charges,80% of total billed charges,32.05,37.27,,25.64,percent of total billed charges,37.27% of total billed charges,32.05,37.27,,25.64,percent of total billed charges,37.27% of total billed charges,32.05,37.27,,25.64,percent of total billed charges,37.27% 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,34.4,40,,27.52,percent of total billed charges,40% of total billed charges,32.05,68.8,
BRONC SPEC TRAP,5645742,CDM,270,RC,,,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
CAST BOOT MED,5645742,CDM,270,RC,,,Outpatient,,,61,48.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% 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,24.4,40,,19.52,percent of total billed charges,40% of total billed charges,22.73,48.8,
CAST PADDING SPEC,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
CAST PADDING DELTA,5645742,CDM,270,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
CAST SPLINT DELTA,5645742,CDM,270,RC,,,Outpatient,,,46,36.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% 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,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,17.14,36.8,
CAST TAPE DELTA,5645742,CDM,270,RC,,,Outpatient,,,30,24.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% 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,12,40,,9.6,percent of total billed charges,40% of total billed charges,11.18,24,
CERVICAL COLLAR FOAM,5645742,CDM,270,RC,,,Outpatient,,,47,37.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% 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,18.8,40,,15.04,percent of total billed charges,40% of total billed charges,17.52,37.6,
CLAVICLE STRAP X-SM,5645742,CDM,270,RC,,,Outpatient,,,19,15.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% 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,7.6,40,,6.08,percent of total billed charges,40% of total billed charges,7.08,15.2,
"INTRACATH 22G, 8",5645742,CDM,270,RC,,,Outpatient,,,26,20.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% 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,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,9.69,20.8,
TUBE LAVACUATOR,5645742,CDM,270,RC,,,Outpatient,,,56,44.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% 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,22.4,40,,17.92,percent of total billed charges,40% of total billed charges,20.87,44.8,
CRUTCH,5645742,CDM,270,RC,,,Outpatient,,,81,64.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% 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,32.4,40,,25.92,percent of total billed charges,40% of total billed charges,30.19,64.8,
LENS MORGAN THERAPEU,5645742,CDM,270,RC,,,Outpatient,,,115,92.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% 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,46,40,,36.8,percent of total billed charges,40% of total billed charges,42.86,92,
SUTURE 7232 51,5801832,CDM,272,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
EAR CURETTES FLEX LP,5645742,CDM,270,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
EAR OR NOSE TRAY,5645742,CDM,270,RC,,,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% 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,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,18.26,39.2,
FLEETS ENEMA,5645742,CDM,270,RC,,,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
IMMOBLZR ARM&SHD MXL,5645742,CDM,270,RC,,,Outpatient,,,68,54.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% 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,27.2,40,,21.76,percent of total billed charges,40% of total billed charges,25.34,54.4,
SPLINT HAND,5645742,CDM,270,RC,,,Outpatient,,,108,86.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% 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,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,40.25,86.4,
SPLINT COLLES,5645742,CDM,270,RC,,,Outpatient,,,77,61.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% 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,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,28.7,61.6,
SPLINT METACARPEL,5645742,CDM,270,RC,,,Outpatient,,,112,89.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% 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,44.8,40,,35.84,percent of total billed charges,40% of total billed charges,41.74,89.6,
SPLINT WRIST COCKUP,5645742,CDM,270,RC,,,Outpatient,,,68,54.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% 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,27.2,40,,21.76,percent of total billed charges,40% of total billed charges,25.34,54.4,
SPLINT POST ELBOW,5645742,CDM,270,RC,,,Outpatient,,,108,86.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% 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,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,40.25,86.4,
SPLINT ARM,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
YANKAUER SUCTION INS,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
SUTURE G112H,5801832,CDM,272,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
SPLNT WRIST R/L SMXL,5645742,CDM,270,RC,,,Outpatient,,,72,57.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,80,,46.08,percent of total billed charges,80% of total billed charges,26.83,37.27,,21.46,percent of total billed charges,37.27% of total billed charges,26.83,37.27,,21.46,percent of total billed charges,37.27% of total billed charges,26.83,37.27,,21.46,percent of total billed charges,37.27% 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,28.8,40,,23.04,percent of total billed charges,40% of total billed charges,26.83,57.6,
IV NITROGLYCERIN SET,5645742,CDM,270,RC,,,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% 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,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,10.06,21.6,
OCL SPLINTING ROLL,5645742,CDM,270,RC,,,Outpatient,,,36,28.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% 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,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,13.42,28.8,
ER DELIVERY W/O EPIS,8830002,CDM,450,RC,SURG,HCPCS,Outpatient,,,2518,2014.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2014.4,80,,1611.52,percent of total billed charges,80% of total billed charges,938.46,37.27,,750.77,percent of total billed charges,37.27% of total billed charges,938.46,37.27,,750.77,percent of total billed charges,37.27% of total billed charges,938.46,37.27,,750.77,percent of total billed charges,37.27% 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,1007.2,40,,805.76,percent of total billed charges,40% of total billed charges,938.46,2014.4,
RIB BELT FEMALE MEDI,5645742,CDM,270,RC,,,Outpatient,,,62,49.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% 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,24.8,40,,19.84,percent of total billed charges,40% of total billed charges,23.11,49.6,
TUBE TRACH 8 DCFS,5645742,CDM,270,RC,,,Outpatient,,,101,80.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% 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,40.4,40,,32.32,percent of total billed charges,40% of total billed charges,37.64,80.8,
SPLINT ALUM FINGER,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
SPLINT LEG 24,5645742,CDM,270,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
SPLINT POST BLW KNEE,5645742,CDM,270,RC,,,Outpatient,,,168,134.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% 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,67.2,40,,53.76,percent of total billed charges,40% of total billed charges,62.61,134.4,
SPLINT POST LONG LEG,5645742,CDM,270,RC,,,Outpatient,,,168,134.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% 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,67.2,40,,53.76,percent of total billed charges,40% of total billed charges,62.61,134.4,
ACROMIO CLAVICAL SPL,5645742,CDM,270,RC,,,Outpatient,,,111,88.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,80,,71.04,percent of total billed charges,80% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% of total billed charges,41.37,37.27,,33.1,percent of total billed charges,37.27% 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,44.4,40,,35.52,percent of total billed charges,40% of total billed charges,41.37,88.8,
SUTURE SN1663/1663H,5801832,CDM,272,RC,,,Outpatient,,,21,16.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% 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,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,7.83,16.8,
SUTURE SN1666/1666H,5801832,CDM,272,RC,,,Outpatient,,,20,16.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% 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,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
SUTURE 1669H,5801832,CDM,272,RC,,,Outpatient,,,88,70.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% 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,35.2,40,,28.16,percent of total billed charges,40% of total billed charges,32.8,70.4,
SUTURE 1675G,5801832,CDM,272,RC,,,Outpatient,,,19,15.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% 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,7.6,40,,6.08,percent of total billed charges,40% of total billed charges,7.08,15.2,
SUTURE 662G/SN662,5801832,CDM,272,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
SUTURE SS683/683G,5801832,CDM,272,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
SUTURE 663H,5801832,CDM,272,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
SUTURE 723G - ETHICO,5801832,CDM,272,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
SUTURE GL885,5801832,CDM,272,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
SUTURE 7612 31/SL691,5801832,CDM,272,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
SUTURE 8649,5801832,CDM,272,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
SUTURE SP1681,5801832,CDM,272,RC,,,Outpatient,,,23,18.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% 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,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,8.57,18.4,
SUTURE 8684G/SP684,5801832,CDM,272,RC,,,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% 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,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,8.94,19.2,
SUTURE G121H - ETHIC,5801832,CDM,272,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
SUTURE G696G,5801832,CDM,272,RC,,,Outpatient,,,30,24.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% 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,12,40,,9.6,percent of total billed charges,40% of total billed charges,11.18,24,
ANKLE BRACE MED,5645742,CDM,270,RC,,,Outpatient,,,118,94.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% 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,47.2,40,,37.76,percent of total billed charges,40% of total billed charges,43.98,94.4,
SUTURE J423H/SL822,5801832,CDM,272,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
SUTURE J496G/SL1627,5801832,CDM,272,RC,,,Outpatient,,,22,17.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% 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,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,8.2,17.6,
HYFRECATOR TIP,5645742,CDM,270,RC,,,Outpatient,,,21,16.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% 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,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,7.83,16.8,
INFLUENZA VACCINE,6065130,CDM,636,RC,90658,HCPCS,Outpatient,,,16,12.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.86,100,,,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,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,5.96,21.86,
KALTOSTAT 3 X 4 3/4,5645742,CDM,270,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
MRA HEAD/BRAIN WO CO,6220313,CDM,611,RC,70544,HCPCS,Outpatient,,,3016,2412.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,210.53,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,202.03,2412.8,
MRA NECK WO CONT,6230478,CDM,615,RC,70547,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,210.95,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,202.03,2412.8,
MRI BRAIN W&WO CONT,6220313,CDM,611,RC,70553,HCPCS,Outpatient,,,3564,2851.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,279.86,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,279.86,2851.2,
MRI BRAIN WO CONT,6220313,CDM,611,RC,70551,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,168.11,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,168.11,2412.8,
MRI CERVICAL WO CONT,6220180,CDM,612,RC,72141,HCPCS,Outpatient,,,3016,2412.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,160.92,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,160.92,2412.8,
MRI LUMBAR W&WO CONT,6220180,CDM,612,RC,72158,HCPCS,Outpatient,,,3564,2851.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,280.71,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,280.71,2851.2,
MRI LUMBAR WO CONT,6220180,CDM,612,RC,72148,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,161.34,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,161.34,2412.8,
CT EXTREM LOWER (W),6010052,CDM,350,RC,73701,HCPCS,Outpatient,,,2124,1699.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1699.2,80,,1359.36,percent of total billed charges,80% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,148.23,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,849.6,40,,679.68,percent of total billed charges,40% of total billed charges,148.23,1699.2,
ELIXOPHYLLIN OZ,6400014,CDM,250,RC,,,Outpatient,,,19.85,15.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.88,80,,12.7,percent of total billed charges,80% of total billed charges,7.4,37.27,,5.92,percent of total billed charges,37.27% of total billed charges,7.4,37.27,,5.92,percent of total billed charges,37.27% of total billed charges,7.4,37.27,,5.92,percent of total billed charges,37.27% 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,7.94,40,,6.35,percent of total billed charges,40% of total billed charges,7.4,15.88,
ENDAL HD OZ,6400014,CDM,250,RC,,,Outpatient,,,13.6,10.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,80,,8.7,percent of total billed charges,80% of total billed charges,5.07,37.27,,4.06,percent of total billed charges,37.27% of total billed charges,5.07,37.27,,4.06,percent of total billed charges,37.27% of total billed charges,5.07,37.27,,4.06,percent of total billed charges,37.27% 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,5.44,40,,4.35,percent of total billed charges,40% of total billed charges,5.07,10.88,
PROMETHAZINE SYP OZ,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
GUIATUSS DM OZ,6400014,CDM,250,RC,,,Outpatient,,,9.6,7.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.68,80,,6.14,percent of total billed charges,80% of total billed charges,3.58,37.27,,2.86,percent of total billed charges,37.27% of total billed charges,3.58,37.27,,2.86,percent of total billed charges,37.27% of total billed charges,3.58,37.27,,2.86,percent of total billed charges,37.27% 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,3.84,40,,3.07,percent of total billed charges,40% of total billed charges,3.58,7.68,
GUIATUSS OZ,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
GUAIFENESIN AC OZ,6400014,CDM,250,RC,,,Outpatient,,,10.3,8.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.24,80,,6.59,percent of total billed charges,80% of total billed charges,3.84,37.27,,3.07,percent of total billed charges,37.27% of total billed charges,3.84,37.27,,3.07,percent of total billed charges,37.27% of total billed charges,3.84,37.27,,3.07,percent of total billed charges,37.27% 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,4.12,40,,3.3,percent of total billed charges,40% of total billed charges,3.84,8.24,
POLYSONOGRAM COMPLT,7612344,CDM,740,RC,95810,HCPCS,Outpatient,,,1530,1224.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1224,80,,979.2,percent of total billed charges,80% of total billed charges,570.23,37.27,,456.18,percent of total billed charges,37.27% of total billed charges,570.23,37.27,,456.18,percent of total billed charges,37.27% of total billed charges,570.23,37.27,,456.18,percent of total billed charges,37.27% of total billed charges,862.05,100,,,fee schedule,100% of APC rate,862.05,100,,,fee schedule,100% of APC rate,862.05,100,,,fee schedule,100% of APC rate,646.73,145,,,fee schedule,145% of CMS fee schedule,862.05,100,,,fee schedule,100% of APC rate,862.05,100,,,fee schedule,100% of APC rate,862.05,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,612,40,,489.6,percent of total billed charges,40% of total billed charges,570.23,1224,
POLYSONOGRAM CPAP,7439094,CDM,410,RC,94660,HCPCS,Outpatient,,,565,452.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,452,80,,361.6,percent of total billed charges,80% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,51.82,145,,,fee schedule,145% of CMS fee schedule,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226,40,,180.8,percent of total billed charges,40% of total billed charges,51.82,452,
EEG 61-119 MIN,7612344,CDM,740,RC,95813,HCPCS,Outpatient,,,675,540.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540,80,,432,percent of total billed charges,80% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% of total billed charges,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,456.43,145,,,fee schedule,145% of CMS fee schedule,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,270,40,,216,percent of total billed charges,40% of total billed charges,251.57,540,
EEG 41-60 MIN,7612344,CDM,740,RC,95812,HCPCS,Outpatient,,,625,500.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,500,80,,400,percent of total billed charges,80% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,374.71,145,,,fee schedule,145% of CMS fee schedule,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,250,40,,200,percent of total billed charges,40% of total billed charges,232.94,500,
IV NS 250 GLASS,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
PAPAVERINE 150MG CAP,6400014,CDM,250,RC,,,Outpatient,,,2.1,1.68,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,80,,1.34,percent of total billed charges,80% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% 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,0.84,40,,0.67,percent of total billed charges,40% of total billed charges,0.78,1.68,
ART LINE INSERTION,6000160,CDM,361,RC,36620,HCPCS,Outpatient,,,1907,1525.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1525.6,80,,1220.48,percent of total billed charges,80% of total billed charges,710.74,37.27,,568.59,percent of total billed charges,37.27% of total billed charges,710.74,37.27,,568.59,percent of total billed charges,37.27% of total billed charges,710.74,37.27,,568.59,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.1,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,762.8,40,,610.24,percent of total billed charges,40% of total billed charges,62.1,1525.6,
VITAL CAPACITY,7439094,CDM,410,RC,94150,HCPCS,Outpatient,,,300,240.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,27.61,145,,,fee schedule,145% of CMS fee schedule,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,27.61,240,
VACUUM EXTRACTOR,5645742,CDM,270,RC,,,Outpatient,,,294,235.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,235.2,80,,188.16,percent of total billed charges,80% of total billed charges,109.57,37.27,,87.66,percent of total billed charges,37.27% of total billed charges,109.57,37.27,,87.66,percent of total billed charges,37.27% of total billed charges,109.57,37.27,,87.66,percent of total billed charges,37.27% 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,117.6,40,,94.08,percent of total billed charges,40% of total billed charges,109.57,235.2,
SENSOR WITH TUBING,5645742,CDM,270,RC,,,Outpatient,,,23,18.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% 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,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,8.57,18.4,
AMNIOINFUSION SETUP,5645742,CDM,270,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
HISTOGRAM,7441215,CDM,460,RC,94762,HCPCS,Outpatient,,,413,330.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,32.26,145,,,fee schedule,145% of CMS fee schedule,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165.2,40,,132.16,percent of total billed charges,40% of total billed charges,32.26,330.4,
OT EVALUATION,6513436,CDM,434,RC,97003,HCPCS,Outpatient,,,246,196.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,91.68,37.27,,73.34,percent of total billed charges,37.27% of total billed charges,91.68,37.27,,73.34,percent of total billed charges,37.27% of total billed charges,91.68,37.27,,73.34,percent of total billed charges,37.27% 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,98.4,40,,78.72,percent of total billed charges,40% of total billed charges,91.68,196.8,
BUCKS TRACTION SPLNT,5645742,CDM,270,RC,,,Outpatient,,,99,79.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% 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,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,36.9,79.2,
KETEK 400MG TAB,6400014,CDM,250,RC,,,Outpatient,,,29.25,23.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.4,80,,18.72,percent of total billed charges,80% of total billed charges,10.9,37.27,,8.72,percent of total billed charges,37.27% of total billed charges,10.9,37.27,,8.72,percent of total billed charges,37.27% of total billed charges,10.9,37.27,,8.72,percent of total billed charges,37.27% 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,11.7,40,,9.36,percent of total billed charges,40% of total billed charges,10.9,23.4,
DYTAN D TAB,6400014,CDM,250,RC,,,Outpatient,,,5.4,4.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.32,80,,3.46,percent of total billed charges,80% of total billed charges,2.01,37.27,,1.61,percent of total billed charges,37.27% of total billed charges,2.01,37.27,,1.61,percent of total billed charges,37.27% of total billed charges,2.01,37.27,,1.61,percent of total billed charges,37.27% 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,2.16,40,,1.73,percent of total billed charges,40% of total billed charges,2.01,4.32,
ANTIBODY SCREEN,7000169,CDM,302,RC,86850,HCPCS,Outpatient,,,118,94.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,9.77,100,,,fee schedule,100% of CMS fee schedule,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,40,,37.76,percent of total billed charges,40% of total billed charges,9.77,94.4,
CYMBALTA 20MG,6400014,CDM,250,RC,,,Outpatient,,,34.1,27.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.28,80,,21.82,percent of total billed charges,80% of total billed charges,12.71,37.27,,10.17,percent of total billed charges,37.27% of total billed charges,12.71,37.27,,10.17,percent of total billed charges,37.27% of total billed charges,12.71,37.27,,10.17,percent of total billed charges,37.27% 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,13.64,40,,10.91,percent of total billed charges,40% of total billed charges,12.71,27.28,
CYMBALTA 30MG,6400014,CDM,250,RC,,,Outpatient,,,32.4,25.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,80,,20.74,percent of total billed charges,80% of total billed charges,12.08,37.27,,9.66,percent of total billed charges,37.27% of total billed charges,12.08,37.27,,9.66,percent of total billed charges,37.27% of total billed charges,12.08,37.27,,9.66,percent of total billed charges,37.27% 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,12.96,40,,10.37,percent of total billed charges,40% of total billed charges,12.08,25.92,
KEPPRA 500MG TAB,6400014,CDM,250,RC,,,Outpatient,,,12.85,10.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.28,80,,8.22,percent of total billed charges,80% of total billed charges,4.79,37.27,,3.83,percent of total billed charges,37.27% of total billed charges,4.79,37.27,,3.83,percent of total billed charges,37.27% of total billed charges,4.79,37.27,,3.83,percent of total billed charges,37.27% 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,5.14,40,,4.11,percent of total billed charges,40% of total billed charges,4.79,10.28,
IMITREX 100MG TAB,6400014,CDM,250,RC,,,Outpatient,,,97.15,77.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.72,80,,62.18,percent of total billed charges,80% of total billed charges,36.21,37.27,,28.97,percent of total billed charges,37.27% of total billed charges,36.21,37.27,,28.97,percent of total billed charges,37.27% of total billed charges,36.21,37.27,,28.97,percent of total billed charges,37.27% 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,38.86,40,,31.09,percent of total billed charges,40% of total billed charges,36.21,77.72,
DIOVAN 160MG TAB,6400014,CDM,250,RC,,,Outpatient,,,40.65,32.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.52,80,,26.02,percent of total billed charges,80% of total billed charges,15.15,37.27,,12.12,percent of total billed charges,37.27% of total billed charges,15.15,37.27,,12.12,percent of total billed charges,37.27% of total billed charges,15.15,37.27,,12.12,percent of total billed charges,37.27% 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,16.26,40,,13.01,percent of total billed charges,40% of total billed charges,15.15,32.52,
COD LIVER OIL CAP,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PHENYTOIN 100MG,6400014,CDM,250,RC,,,Outpatient,,,2.2,1.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,80,,1.41,percent of total billed charges,80% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% 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,0.88,40,,0.7,percent of total billed charges,40% of total billed charges,0.82,1.76,
CIPROFLOXACIN 500MG,6065130,CDM,636,RC,J0744,HCPCS,Outpatient,,,20.95,16.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.76,80,,13.41,percent of total billed charges,80% of total billed charges,7.81,37.27,,6.25,percent of total billed charges,37.27% of total billed charges,7.81,37.27,,6.25,percent of total billed charges,37.27% of total billed charges,7.81,37.27,,6.25,percent of total billed charges,37.27% 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,8.38,40,,6.7,percent of total billed charges,40% of total billed charges,7.81,16.76,
RHINOCON A,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
GLYNASE 3MG,6400014,CDM,250,RC,,,Outpatient,,,2.15,1.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.72,80,,1.38,percent of total billed charges,80% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% 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,0.86,40,,0.69,percent of total billed charges,40% of total billed charges,0.8,1.72,
LEVOTHROID 125MCG,6400014,CDM,250,RC,,,Outpatient,,,6.45,5.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.16,80,,4.13,percent of total billed charges,80% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% 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,2.58,40,,2.06,percent of total billed charges,40% of total billed charges,2.4,5.16,
ZOCOR 20MG,6400014,CDM,250,RC,,,Outpatient,,,20.95,16.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.76,80,,13.41,percent of total billed charges,80% of total billed charges,7.81,37.27,,6.25,percent of total billed charges,37.27% of total billed charges,7.81,37.27,,6.25,percent of total billed charges,37.27% of total billed charges,7.81,37.27,,6.25,percent of total billed charges,37.27% 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,8.38,40,,6.7,percent of total billed charges,40% of total billed charges,7.81,16.76,
KRISTALOSE,6400014,CDM,250,RC,,,Outpatient,,,41.95,33.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.56,80,,26.85,percent of total billed charges,80% of total billed charges,15.63,37.27,,12.5,percent of total billed charges,37.27% of total billed charges,15.63,37.27,,12.5,percent of total billed charges,37.27% of total billed charges,15.63,37.27,,12.5,percent of total billed charges,37.27% 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,16.78,40,,13.42,percent of total billed charges,40% of total billed charges,15.63,33.56,
DIAZEPAM 10MG,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
PREMARIN 0.45MG,6400014,CDM,250,RC,,,Outpatient,,,8.55,6.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.84,80,,5.47,percent of total billed charges,80% of total billed charges,3.19,37.27,,2.55,percent of total billed charges,37.27% of total billed charges,3.19,37.27,,2.55,percent of total billed charges,37.27% of total billed charges,3.19,37.27,,2.55,percent of total billed charges,37.27% 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,3.42,40,,2.74,percent of total billed charges,40% of total billed charges,3.19,6.84,
DIPYRIDAMOLE 75MG,6400014,CDM,250,RC,,,Outpatient,,,3.15,2.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,80,,2.02,percent of total billed charges,80% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% 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,1.26,40,,1.01,percent of total billed charges,40% of total billed charges,1.17,2.52,
IV SOD CHL 0.45% 500,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
MRA ABDOMEN W/O CONS,,,618,RC,74185,HCPCS,Outpatient,,,3016,2412.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,334.11,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,334.11,2412.8,
MRI ABDOMEN W/CONTR,6212047,CDM,610,RC,74182,HCPCS,Outpatient,,,3290,2632.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2632,80,,2105.6,percent of total billed charges,80% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,292.55,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,40,,1052.8,percent of total billed charges,40% of total billed charges,292.55,2632,
MRI ANKLE W CONTRAST,6212047,CDM,610,RC,73722,HCPCS,Outpatient,,,3290,2632.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2632,80,,2105.6,percent of total billed charges,80% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,313.27,145,,,fee schedule,145% of CMS fee schedule,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,40,,1052.8,percent of total billed charges,40% of total billed charges,313.27,2632,
MRI BRAIN W CONTRAST,6220313,CDM,611,RC,70552,HCPCS,Outpatient,,,3290,2632.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2632,80,,2105.6,percent of total billed charges,80% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,247.31,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,40,,1052.8,percent of total billed charges,40% of total billed charges,247.31,2632,
MRI CERVICAL W&WO,6220180,CDM,612,RC,72156,HCPCS,Outpatient,,,3564,2851.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,281.56,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,281.56,2851.2,
MRI CERVICAL W CONT,6220180,CDM,612,RC,72142,HCPCS,Outpatient,,,3290,2632.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2632,80,,2105.6,percent of total billed charges,80% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,253.23,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,40,,1052.8,percent of total billed charges,40% of total billed charges,253.23,2632,
MRI CHEST WO CONT,6212047,CDM,610,RC,71550,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,354.7,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,202.03,2412.8,
MRI CHEST W/WO CONT,6212047,CDM,610,RC,71552,HCPCS,Outpatient,,,3564,2851.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,481.68,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,317.08,2851.2,
MRI CHEST W CONTRAST,6212047,CDM,610,RC,71551,HCPCS,Outpatient,,,3290,2632.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2632,80,,2105.6,percent of total billed charges,80% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,385.15,145,,,fee schedule,145% of CMS fee schedule,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,40,,1052.8,percent of total billed charges,40% of total billed charges,385.15,2632,
MRI FOOT WO CONT,6212047,CDM,610,RC,73721,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,183.76,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,183.76,2412.8,
MRI FOOT W CONT,6212047,CDM,610,RC,73722,HCPCS,Outpatient,,,3290,2632.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2632,80,,2105.6,percent of total billed charges,80% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,313.27,145,,,fee schedule,145% of CMS fee schedule,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,40,,1052.8,percent of total billed charges,40% of total billed charges,313.27,2632,
MRI THORACIC WO CONT,6220180,CDM,612,RC,72146,HCPCS,Outpatient,,,3016,2412.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,160.5,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,160.5,2412.8,
MRI KNEE WO CONT,6212047,CDM,610,RC,73721,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,183.76,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,183.76,2412.8,
MRI KNEE W CONTRAST,6212047,CDM,610,RC,73722,HCPCS,Outpatient,,,3290,2632.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2632,80,,2105.6,percent of total billed charges,80% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,313.27,145,,,fee schedule,145% of CMS fee schedule,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,40,,1052.8,percent of total billed charges,40% of total billed charges,313.27,2632,
MRI THORACIC W&WO,6220180,CDM,612,RC,72157,HCPCS,Outpatient,,,3564,2851.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,282.4,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,282.4,2851.2,
MRI PELVIS W&WO,6212047,CDM,610,RC,72197,HCPCS,Outpatient,,,3564,2851.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,309.46,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,309.46,2851.2,
MRI PELVIS W/O CONT,6212047,CDM,610,RC,72195,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,212.08,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,202.03,2412.8,
MRI LOWEXT NO JNT W,6212047,CDM,610,RC,73719,HCPCS,Outpatient,,,3290,2632.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2632,80,,2105.6,percent of total billed charges,80% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,247.73,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,40,,1052.8,percent of total billed charges,40% of total billed charges,247.73,2632,
FOSAMAX 35MG TAB,6400014,CDM,250,RC,,,Outpatient,,,80.3,64.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.24,80,,51.39,percent of total billed charges,80% of total billed charges,29.93,37.27,,23.94,percent of total billed charges,37.27% of total billed charges,29.93,37.27,,23.94,percent of total billed charges,37.27% of total billed charges,29.93,37.27,,23.94,percent of total billed charges,37.27% 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,32.12,40,,25.7,percent of total billed charges,40% of total billed charges,29.93,64.24,
AVODART 0.5 MG CAP,6400014,CDM,250,RC,,,Outpatient,,,39.05,31.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.24,80,,24.99,percent of total billed charges,80% of total billed charges,14.55,37.27,,11.64,percent of total billed charges,37.27% of total billed charges,14.55,37.27,,11.64,percent of total billed charges,37.27% of total billed charges,14.55,37.27,,11.64,percent of total billed charges,37.27% 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,15.62,40,,12.5,percent of total billed charges,40% of total billed charges,14.55,31.24,
NOVOLOG INSULIN,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,96.5,77.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.2,80,,61.76,percent of total billed charges,80% of total billed charges,35.97,37.27,,28.78,percent of total billed charges,37.27% of total billed charges,35.97,37.27,,28.78,percent of total billed charges,37.27% of total billed charges,35.97,37.27,,28.78,percent of total billed charges,37.27% 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,38.6,40,,30.88,percent of total billed charges,40% of total billed charges,35.97,77.2,
NOVOLIN R INSULIN,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,64.2,51.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.36,80,,41.09,percent of total billed charges,80% of total billed charges,23.93,37.27,,19.14,percent of total billed charges,37.27% of total billed charges,23.93,37.27,,19.14,percent of total billed charges,37.27% of total billed charges,23.93,37.27,,19.14,percent of total billed charges,37.27% 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,25.68,40,,20.54,percent of total billed charges,40% of total billed charges,23.93,51.36,
MEPERIDINE 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,10.6,8.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.48,80,,6.78,percent of total billed charges,80% of total billed charges,3.95,37.27,,3.16,percent of total billed charges,37.27% of total billed charges,3.95,37.27,,3.16,percent of total billed charges,37.27% of total billed charges,3.95,37.27,,3.16,percent of total billed charges,37.27% 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,4.24,40,,3.39,percent of total billed charges,40% of total billed charges,3.95,8.48,
FLUCONAZOLE 150MG TA,6400014,CDM,250,RC,,,Outpatient,,,54.75,43.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.8,80,,35.04,percent of total billed charges,80% of total billed charges,20.41,37.27,,16.33,percent of total billed charges,37.27% of total billed charges,20.41,37.27,,16.33,percent of total billed charges,37.27% of total billed charges,20.41,37.27,,16.33,percent of total billed charges,37.27% 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,21.9,40,,17.52,percent of total billed charges,40% of total billed charges,20.41,43.8,
DILTIAZEM 25MG/5ML,6065130,CDM,636,RC,J3490,HCPCS,Outpatient,,,16.5,13.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,80,,10.56,percent of total billed charges,80% of total billed charges,6.15,37.27,,4.92,percent of total billed charges,37.27% of total billed charges,6.15,37.27,,4.92,percent of total billed charges,37.27% of total billed charges,6.15,37.27,,4.92,percent of total billed charges,37.27% 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,6.6,40,,5.28,percent of total billed charges,40% of total billed charges,6.15,13.2,
ALBUTEROL 20ML SOL,6400014,CDM,250,RC,,,Outpatient,,,70.9,56.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.72,80,,45.38,percent of total billed charges,80% of total billed charges,26.42,37.27,,21.14,percent of total billed charges,37.27% of total billed charges,26.42,37.27,,21.14,percent of total billed charges,37.27% of total billed charges,26.42,37.27,,21.14,percent of total billed charges,37.27% 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,28.36,40,,22.69,percent of total billed charges,40% of total billed charges,26.42,56.72,
THEOPHYLLINE CR 100,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
OXAZEPAM 10MG,6400014,CDM,250,RC,,,Outpatient,,,3.65,2.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.92,80,,2.34,percent of total billed charges,80% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% 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,1.46,40,,1.17,percent of total billed charges,40% of total billed charges,1.36,2.92,
TALWIN 30MG/ML,6065130,CDM,636,RC,J3070,HCPCS,Outpatient,,,491.05,392.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,392.84,80,,314.27,percent of total billed charges,80% of total billed charges,183.01,37.27,,146.41,percent of total billed charges,37.27% of total billed charges,183.01,37.27,,146.41,percent of total billed charges,37.27% of total billed charges,183.01,37.27,,146.41,percent of total billed charges,37.27% 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,196.42,40,,157.14,percent of total billed charges,40% of total billed charges,183.01,392.84,
ATRACURIUM 10MG/ML,6400014,CDM,250,RC,,,Outpatient,,,70.8,56.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.64,80,,45.31,percent of total billed charges,80% of total billed charges,26.39,37.27,,21.11,percent of total billed charges,37.27% of total billed charges,26.39,37.27,,21.11,percent of total billed charges,37.27% of total billed charges,26.39,37.27,,21.11,percent of total billed charges,37.27% 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,28.32,40,,22.66,percent of total billed charges,40% of total billed charges,26.39,56.64,
ZOCOR 80 MG,6400014,CDM,250,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
HYDROMORPHONE 2MG,6400014,CDM,250,RC,,,Outpatient,,,2.5,2.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
BENTYL 20M/2ML INJ,6065130,CDM,636,RC,J0500,HCPCS,Outpatient,,,343.95,275.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,275.16,80,,220.13,percent of total billed charges,80% of total billed charges,128.19,37.27,,102.55,percent of total billed charges,37.27% of total billed charges,128.19,37.27,,102.55,percent of total billed charges,37.27% of total billed charges,128.19,37.27,,102.55,percent of total billed charges,37.27% 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,137.58,40,,110.06,percent of total billed charges,40% of total billed charges,128.19,275.16,
BUTORPHANOL 2MG/ML,6065130,CDM,636,RC,J0595,HCPCS,Outpatient,,,22.25,17.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.8,80,,14.24,percent of total billed charges,80% of total billed charges,8.29,37.27,,6.63,percent of total billed charges,37.27% of total billed charges,8.29,37.27,,6.63,percent of total billed charges,37.27% of total billed charges,8.29,37.27,,6.63,percent of total billed charges,37.27% 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,8.9,40,,7.12,percent of total billed charges,40% of total billed charges,8.29,17.8,
TELEMETRY-ICU,22004,CDM,206,RC,,,Inpatient,,,1297,1037.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1037.6,80,,830.08,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,1037.6,1037.6,
INSPRA 25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,20.15,16.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.12,80,,12.9,percent of total billed charges,80% of total billed charges,7.51,37.27,,6.01,percent of total billed charges,37.27% of total billed charges,7.51,37.27,,6.01,percent of total billed charges,37.27% of total billed charges,7.51,37.27,,6.01,percent of total billed charges,37.27% 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,8.06,40,,6.45,percent of total billed charges,40% of total billed charges,7.51,16.12,
PROCRIT 2000U 2X,6065130,CDM,636,RC,J0885,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,7.53,300,
PROCRIT 40000U X40,6065130,CDM,636,RC,J0885,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,7.53,300,
PROCRIT 10000U X10,6065130,CDM,636,RC,J0885,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,7.53,300,
PROCRIT 3000U  X3,6065130,CDM,636,RC,J0885,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,7.53,300,
PCA DILAUDID 0.2MG,6400014,CDM,250,RC,,,Outpatient,,,162.5,130.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130,80,,104,percent of total billed charges,80% of total billed charges,60.56,37.27,,48.45,percent of total billed charges,37.27% of total billed charges,60.56,37.27,,48.45,percent of total billed charges,37.27% of total billed charges,60.56,37.27,,48.45,percent of total billed charges,37.27% 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,65,40,,52,percent of total billed charges,40% of total billed charges,60.56,130,
AMOXICILLIN 250MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
AMOXICILLIN 250MG,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
BOUDREAUX'S PASTE,6400014,CDM,250,RC,,,Outpatient,,,19.45,15.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.56,80,,12.45,percent of total billed charges,80% of total billed charges,7.25,37.27,,5.8,percent of total billed charges,37.27% of total billed charges,7.25,37.27,,5.8,percent of total billed charges,37.27% of total billed charges,7.25,37.27,,5.8,percent of total billed charges,37.27% 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,7.78,40,,6.22,percent of total billed charges,40% of total billed charges,7.25,15.56,
CEPHALEXIN 500MG CAP,6400014,CDM,250,RC,,,Outpatient,,,5.1,4.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.08,80,,3.26,percent of total billed charges,80% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% 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,2.04,40,,1.63,percent of total billed charges,40% of total billed charges,1.9,4.08,
CIMETIDINE 150MG/ML,6400014,CDM,250,RC,,,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
CLONIDINE 0.3 MG,6400014,CDM,250,RC,,,Outpatient,,,1.7,1.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.36,80,,1.09,percent of total billed charges,80% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% 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,0.68,40,,0.54,percent of total billed charges,40% of total billed charges,0.63,1.36,
VITAMIN B6 100MG INJ,6400014,CDM,250,RC,,,Outpatient,,,88.9,71.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.12,80,,56.9,percent of total billed charges,80% of total billed charges,33.13,37.27,,26.5,percent of total billed charges,37.27% of total billed charges,33.13,37.27,,26.5,percent of total billed charges,37.27% of total billed charges,33.13,37.27,,26.5,percent of total billed charges,37.27% 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,35.56,40,,28.45,percent of total billed charges,40% of total billed charges,33.13,71.12,
PHENO-BELLA 16.2 MG,6400014,CDM,250,RC,,,Outpatient,,,31.8,25.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.44,80,,20.35,percent of total billed charges,80% of total billed charges,11.85,37.27,,9.48,percent of total billed charges,37.27% of total billed charges,11.85,37.27,,9.48,percent of total billed charges,37.27% of total billed charges,11.85,37.27,,9.48,percent of total billed charges,37.27% 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,12.72,40,,10.18,percent of total billed charges,40% of total billed charges,11.85,25.44,
BENADRYL CREAM,6400014,CDM,250,RC,,,Outpatient,,,12.15,9.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.72,80,,7.78,percent of total billed charges,80% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% 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,4.86,40,,3.89,percent of total billed charges,40% of total billed charges,4.53,9.72,
DIMENHYDRINATE 50MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
DEXAMETHASONE 0.1%,6400014,CDM,250,RC,,,Outpatient,,,168.8,135.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.04,80,,108.03,percent of total billed charges,80% of total billed charges,62.91,37.27,,50.33,percent of total billed charges,37.27% of total billed charges,62.91,37.27,,50.33,percent of total billed charges,37.27% of total billed charges,62.91,37.27,,50.33,percent of total billed charges,37.27% 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,67.52,40,,54.02,percent of total billed charges,40% of total billed charges,62.91,135.04,
DAKINS HALF-STRENGTH,6400014,CDM,250,RC,,,Outpatient,,,47.95,38.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.36,80,,30.69,percent of total billed charges,80% of total billed charges,17.87,37.27,,14.3,percent of total billed charges,37.27% of total billed charges,17.87,37.27,,14.3,percent of total billed charges,37.27% of total billed charges,17.87,37.27,,14.3,percent of total billed charges,37.27% 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,19.18,40,,15.34,percent of total billed charges,40% of total billed charges,17.87,38.36,
APAP #4,6400014,CDM,250,RC,,,Outpatient,,,3.9,3.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.12,80,,2.5,percent of total billed charges,80% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% 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,1.56,40,,1.25,percent of total billed charges,40% of total billed charges,1.45,3.12,
DIMENHYDRINATE MG/ML,6065130,CDM,636,RC,J1240,HCPCS,Outpatient,,,47.15,37.72,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.72,80,,30.18,percent of total billed charges,80% of total billed charges,17.57,37.27,,14.06,percent of total billed charges,37.27% of total billed charges,17.57,37.27,,14.06,percent of total billed charges,37.27% of total billed charges,17.57,37.27,,14.06,percent of total billed charges,37.27% 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,18.86,40,,15.09,percent of total billed charges,40% of total billed charges,17.57,37.72,
DIAPER RASH OINT,6400014,CDM,250,RC,,,Outpatient,,,9.55,7.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.64,80,,6.11,percent of total billed charges,80% of total billed charges,3.56,37.27,,2.85,percent of total billed charges,37.27% of total billed charges,3.56,37.27,,2.85,percent of total billed charges,37.27% of total billed charges,3.56,37.27,,2.85,percent of total billed charges,37.27% 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,3.82,40,,3.06,percent of total billed charges,40% of total billed charges,3.56,7.64,
PREVACID 30MG INJ,6400014,CDM,250,RC,,,Outpatient,,,97,77.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% 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,38.8,40,,31.04,percent of total billed charges,40% of total billed charges,36.15,77.6,
FLUOXETINE 10MG,6400014,CDM,250,RC,,,Outpatient,,,9.75,7.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,80,,6.24,percent of total billed charges,80% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% 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,3.9,40,,3.12,percent of total billed charges,40% of total billed charges,3.63,7.8,
DILTIAZEM 50MG/10ML,6400014,CDM,250,RC,,,Outpatient,,,33,26.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% 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,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,12.3,26.4,
DOXEPIN 25MG CAP,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ELTA LITE 3OZ,6400014,CDM,250,RC,,,Outpatient,,,13.53,10.82,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.82,80,,8.66,percent of total billed charges,80% of total billed charges,5.04,37.27,,4.03,percent of total billed charges,37.27% of total billed charges,5.04,37.27,,4.03,percent of total billed charges,37.27% of total billed charges,5.04,37.27,,4.03,percent of total billed charges,37.27% 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,5.41,40,,4.33,percent of total billed charges,40% of total billed charges,5.04,10.82,
ERYTHROMYC 200MG/5ML,6065130,CDM,636,RC,J1364,HCPCS,Outpatient,,,1142.25,913.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,913.8,80,,731.04,percent of total billed charges,80% of total billed charges,425.72,37.27,,340.58,percent of total billed charges,37.27% of total billed charges,425.72,37.27,,340.58,percent of total billed charges,37.27% of total billed charges,425.72,37.27,,340.58,percent of total billed charges,37.27% of total billed charges,56.57,100,,,fee schedule,100% of APC rate,56.57,100,,,fee schedule,100% of APC rate,56.57,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,56.57,100,,,fee schedule,100% of APC rate,56.57,100,,,fee schedule,100% of APC rate,56.57,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,456.9,40,,365.52,percent of total billed charges,40% of total billed charges,56.57,913.8,
IODOSORB GEL 40GM,6400014,CDM,250,RC,,,Outpatient,,,398.85,319.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,319.08,80,,255.26,percent of total billed charges,80% of total billed charges,148.65,37.27,,118.92,percent of total billed charges,37.27% of total billed charges,148.65,37.27,,118.92,percent of total billed charges,37.27% of total billed charges,148.65,37.27,,118.92,percent of total billed charges,37.27% 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,159.54,40,,127.63,percent of total billed charges,40% of total billed charges,148.65,319.08,
GARLIQUE 400MG EC,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
GAVISCON LIQUID,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
ZOVIRAX 5% CREAM,6400014,CDM,250,RC,,,Outpatient,,,122.25,97.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.8,80,,78.24,percent of total billed charges,80% of total billed charges,45.56,37.27,,36.45,percent of total billed charges,37.27% of total billed charges,45.56,37.27,,36.45,percent of total billed charges,37.27% of total billed charges,45.56,37.27,,36.45,percent of total billed charges,37.27% 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,48.9,40,,39.12,percent of total billed charges,40% of total billed charges,45.56,97.8,
STRESS W/ZINC,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
LIPITOR 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,24.1,19.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.28,80,,15.42,percent of total billed charges,80% of total billed charges,8.98,37.27,,7.18,percent of total billed charges,37.27% of total billed charges,8.98,37.27,,7.18,percent of total billed charges,37.27% of total billed charges,8.98,37.27,,7.18,percent of total billed charges,37.27% 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,9.64,40,,7.71,percent of total billed charges,40% of total billed charges,8.98,19.28,
P-EPHED/TRIPROLIDINE,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ALDACTAZIDE 50/50,6400014,CDM,250,RC,,,Outpatient,,,10.75,8.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.6,80,,6.88,percent of total billed charges,80% of total billed charges,4.01,37.27,,3.21,percent of total billed charges,37.27% of total billed charges,4.01,37.27,,3.21,percent of total billed charges,37.27% of total billed charges,4.01,37.27,,3.21,percent of total billed charges,37.27% 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,4.3,40,,3.44,percent of total billed charges,40% of total billed charges,4.01,8.6,
CHLORPROPAMIDE 100MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CILOXAN 0.3% OPHTH,6400014,CDM,250,RC,,,Outpatient,,,237.45,189.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.96,80,,151.97,percent of total billed charges,80% of total billed charges,88.5,37.27,,70.8,percent of total billed charges,37.27% of total billed charges,88.5,37.27,,70.8,percent of total billed charges,37.27% of total billed charges,88.5,37.27,,70.8,percent of total billed charges,37.27% 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,94.98,40,,75.98,percent of total billed charges,40% of total billed charges,88.5,189.96,
CLEAR EYES,6400014,CDM,250,RC,,,Outpatient,,,13.5,10.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.8,80,,8.64,percent of total billed charges,80% of total billed charges,5.03,37.27,,4.02,percent of total billed charges,37.27% of total billed charges,5.03,37.27,,4.02,percent of total billed charges,37.27% of total billed charges,5.03,37.27,,4.02,percent of total billed charges,37.27% 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,5.4,40,,4.32,percent of total billed charges,40% of total billed charges,5.03,10.8,
BUTORPHANOL 1MG/ML,6065130,CDM,636,RC,J0595,HCPCS,Outpatient,,,30.35,24.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.28,80,,19.42,percent of total billed charges,80% of total billed charges,11.31,37.27,,9.05,percent of total billed charges,37.27% of total billed charges,11.31,37.27,,9.05,percent of total billed charges,37.27% of total billed charges,11.31,37.27,,9.05,percent of total billed charges,37.27% 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,12.14,40,,9.71,percent of total billed charges,40% of total billed charges,11.31,24.28,
LEVOBUNOLOL 0.5% OP,6400014,CDM,250,RC,,,Outpatient,,,82.45,65.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.96,80,,52.77,percent of total billed charges,80% of total billed charges,30.73,37.27,,24.58,percent of total billed charges,37.27% of total billed charges,30.73,37.27,,24.58,percent of total billed charges,37.27% of total billed charges,30.73,37.27,,24.58,percent of total billed charges,37.27% 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,32.98,40,,26.38,percent of total billed charges,40% of total billed charges,30.73,65.96,
LIDA MANTLE 3OZ,6400014,CDM,250,RC,,,Outpatient,,,632,505.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,505.6,80,,404.48,percent of total billed charges,80% of total billed charges,235.55,37.27,,188.44,percent of total billed charges,37.27% of total billed charges,235.55,37.27,,188.44,percent of total billed charges,37.27% of total billed charges,235.55,37.27,,188.44,percent of total billed charges,37.27% 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,252.8,40,,202.24,percent of total billed charges,40% of total billed charges,235.55,505.6,
GLADASE-C OINTMENT,6400014,CDM,250,RC,,,Outpatient,,,207.9,166.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.32,80,,133.06,percent of total billed charges,80% of total billed charges,77.48,37.27,,61.98,percent of total billed charges,37.27% of total billed charges,77.48,37.27,,61.98,percent of total billed charges,37.27% of total billed charges,77.48,37.27,,61.98,percent of total billed charges,37.27% 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,83.16,40,,66.53,percent of total billed charges,40% of total billed charges,77.48,166.32,
CHLOROTHIAZIDE 500MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
DERMAGRAFT,6065130,CDM,636,RC,Q4106,HCPCS,Outpatient,,,109,87.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% 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,43.6,40,,34.88,percent of total billed charges,40% of total billed charges,40.62,87.2,
TARKA 4/240,6400014,CDM,250,RC,,,Outpatient,,,18.2,14.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.56,80,,11.65,percent of total billed charges,80% of total billed charges,6.78,37.27,,5.42,percent of total billed charges,37.27% of total billed charges,6.78,37.27,,5.42,percent of total billed charges,37.27% of total billed charges,6.78,37.27,,5.42,percent of total billed charges,37.27% 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,7.28,40,,5.82,percent of total billed charges,40% of total billed charges,6.78,14.56,
LISIN/HCTZ 20/12.5MG,6400014,CDM,250,RC,,,Outpatient,,,4.05,3.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.24,80,,2.59,percent of total billed charges,80% of total billed charges,1.51,37.27,,1.21,percent of total billed charges,37.27% of total billed charges,1.51,37.27,,1.21,percent of total billed charges,37.27% of total billed charges,1.51,37.27,,1.21,percent of total billed charges,37.27% 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,1.62,40,,1.3,percent of total billed charges,40% of total billed charges,1.51,3.24,
SANCTURA 20MG,6400014,CDM,250,RC,,,Outpatient,,,9.95,7.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.96,80,,6.37,percent of total billed charges,80% of total billed charges,3.71,37.27,,2.97,percent of total billed charges,37.27% of total billed charges,3.71,37.27,,2.97,percent of total billed charges,37.27% of total billed charges,3.71,37.27,,2.97,percent of total billed charges,37.27% 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,3.98,40,,3.18,percent of total billed charges,40% of total billed charges,3.71,7.96,
SYMBYAX 6/25,6400014,CDM,250,RC,,,Outpatient,,,54.85,43.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.88,80,,35.1,percent of total billed charges,80% of total billed charges,20.44,37.27,,16.35,percent of total billed charges,37.27% of total billed charges,20.44,37.27,,16.35,percent of total billed charges,37.27% of total billed charges,20.44,37.27,,16.35,percent of total billed charges,37.27% 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,21.94,40,,17.55,percent of total billed charges,40% of total billed charges,20.44,43.88,
ARM CRADLE,5645742,CDM,270,RC,,,Outpatient,,,43,34.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% 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,17.2,40,,13.76,percent of total billed charges,40% of total billed charges,16.03,34.4,
EP VISIT LEVEL 5,5612353,CDM,510,RC,99215,HCPCS,Outpatient,,,319.68,255.74,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,255.74,80,,204.59,percent of total billed charges,80% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.98,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,96.04,255.74,
IV SOLN TRANSFER SET,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
VODKA (OZ),6400014,CDM,250,RC,,,Outpatient,,,7.1,5.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.68,80,,4.54,percent of total billed charges,80% of total billed charges,2.65,37.27,,2.12,percent of total billed charges,37.27% of total billed charges,2.65,37.27,,2.12,percent of total billed charges,37.27% of total billed charges,2.65,37.27,,2.12,percent of total billed charges,37.27% 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,2.84,40,,2.27,percent of total billed charges,40% of total billed charges,2.65,5.68,
ENALAP/HCTZ 10/25 TB,6400014,CDM,250,RC,,,Outpatient,,,4.05,3.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.24,80,,2.59,percent of total billed charges,80% of total billed charges,1.51,37.27,,1.21,percent of total billed charges,37.27% of total billed charges,1.51,37.27,,1.21,percent of total billed charges,37.27% of total billed charges,1.51,37.27,,1.21,percent of total billed charges,37.27% 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,1.62,40,,1.3,percent of total billed charges,40% of total billed charges,1.51,3.24,
TIAZAC 360MG CAP,6400014,CDM,250,RC,,,Outpatient,,,12.15,9.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.72,80,,7.78,percent of total billed charges,80% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% 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,4.86,40,,3.89,percent of total billed charges,40% of total billed charges,4.53,9.72,
NEXIUM 40MG CAP,6400014,CDM,250,RC,,,Outpatient,,,32.25,25.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.8,80,,20.64,percent of total billed charges,80% of total billed charges,12.02,37.27,,9.62,percent of total billed charges,37.27% of total billed charges,12.02,37.27,,9.62,percent of total billed charges,37.27% of total billed charges,12.02,37.27,,9.62,percent of total billed charges,37.27% 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,12.9,40,,10.32,percent of total billed charges,40% of total billed charges,12.02,25.8,
CARBATROL 300MG CAP,6400014,CDM,250,RC,,,Outpatient,,,7.2,5.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,80,,4.61,percent of total billed charges,80% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% 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,2.88,40,,2.3,percent of total billed charges,40% of total billed charges,2.68,5.76,
PANNAZ TAB,6400014,CDM,250,RC,,,Outpatient,,,2.3,1.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.84,80,,1.47,percent of total billed charges,80% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% 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,0.92,40,,0.74,percent of total billed charges,40% of total billed charges,0.86,1.84,
VERELAN PM 100MG,6400014,CDM,250,RC,,,Outpatient,,,15.9,12.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.72,80,,10.18,percent of total billed charges,80% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% of total billed charges,5.93,37.27,,4.74,percent of total billed charges,37.27% 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,6.36,40,,5.09,percent of total billed charges,40% of total billed charges,5.93,12.72,
VERELAN PM 200MG,6400014,CDM,250,RC,,,Outpatient,,,20.5,16.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.4,80,,13.12,percent of total billed charges,80% of total billed charges,7.64,37.27,,6.11,percent of total billed charges,37.27% of total billed charges,7.64,37.27,,6.11,percent of total billed charges,37.27% of total billed charges,7.64,37.27,,6.11,percent of total billed charges,37.27% 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,8.2,40,,6.56,percent of total billed charges,40% of total billed charges,7.64,16.4,
ZOFRAN 4MG ODT,5880901,CDM,637,RC,S0119,HCPCS,Outpatient,,,81.7,65.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.36,80,,52.29,percent of total billed charges,80% of total billed charges,30.45,37.27,,24.36,percent of total billed charges,37.27% of total billed charges,30.45,37.27,,24.36,percent of total billed charges,37.27% of total billed charges,30.45,37.27,,24.36,percent of total billed charges,37.27% 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,32.68,40,,26.14,percent of total billed charges,40% of total billed charges,30.45,65.36,
ZOFRAN 8MG ODT,6400014,CDM,250,RC,,,Outpatient,,,121.8,97.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.44,80,,77.95,percent of total billed charges,80% of total billed charges,45.39,37.27,,36.31,percent of total billed charges,37.27% of total billed charges,45.39,37.27,,36.31,percent of total billed charges,37.27% of total billed charges,45.39,37.27,,36.31,percent of total billed charges,37.27% 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,48.72,40,,38.98,percent of total billed charges,40% of total billed charges,45.39,97.44,
POLY-VI-FL 0.25%,6400014,CDM,250,RC,,,Outpatient,,,118.65,94.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.92,80,,75.94,percent of total billed charges,80% of total billed charges,44.22,37.27,,35.38,percent of total billed charges,37.27% of total billed charges,44.22,37.27,,35.38,percent of total billed charges,37.27% of total billed charges,44.22,37.27,,35.38,percent of total billed charges,37.27% 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,47.46,40,,37.97,percent of total billed charges,40% of total billed charges,44.22,94.92,
DIPIVEFRIN 0.1% GTTS,6400014,CDM,250,RC,,,Outpatient,,,47.95,38.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.36,80,,30.69,percent of total billed charges,80% of total billed charges,17.87,37.27,,14.3,percent of total billed charges,37.27% of total billed charges,17.87,37.27,,14.3,percent of total billed charges,37.27% of total billed charges,17.87,37.27,,14.3,percent of total billed charges,37.27% 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,19.18,40,,15.34,percent of total billed charges,40% of total billed charges,17.87,38.36,
CHILDS MVI/IRON TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
GLUCOTROL XL 2.5MG,6400014,CDM,250,RC,,,Outpatient,,,4.65,3.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.72,80,,2.98,percent of total billed charges,80% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% 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,1.86,40,,1.49,percent of total billed charges,40% of total billed charges,1.73,3.72,
TARKA 2/240 TAB,6400014,CDM,250,RC,,,Outpatient,,,18.2,14.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.56,80,,11.65,percent of total billed charges,80% of total billed charges,6.78,37.27,,5.42,percent of total billed charges,37.27% of total billed charges,6.78,37.27,,5.42,percent of total billed charges,37.27% of total billed charges,6.78,37.27,,5.42,percent of total billed charges,37.27% 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,7.28,40,,5.82,percent of total billed charges,40% of total billed charges,6.78,14.56,
HYDROCORTISONE TB 20,6400014,CDM,250,RC,,,Outpatient,,,3.7,2.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.96,80,,2.37,percent of total billed charges,80% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% 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,1.48,40,,1.18,percent of total billed charges,40% of total billed charges,1.38,2.96,
BEANO TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
NEO-DEXAMETH OPTH,6400014,CDM,250,RC,,,Outpatient,,,67.7,54.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.16,80,,43.33,percent of total billed charges,80% of total billed charges,25.23,37.27,,20.18,percent of total billed charges,37.27% of total billed charges,25.23,37.27,,20.18,percent of total billed charges,37.27% of total billed charges,25.23,37.27,,20.18,percent of total billed charges,37.27% 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,27.08,40,,21.66,percent of total billed charges,40% of total billed charges,25.23,54.16,
EYE LENS,8631483,CDM,276,RC,C1780,HCPCS,Outpatient,,,540,432.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,432,80,,345.6,percent of total billed charges,80% of total billed charges,201.26,37.27,,161.01,percent of total billed charges,37.27% of total billed charges,201.26,37.27,,161.01,percent of total billed charges,37.27% of total billed charges,201.26,37.27,,161.01,percent of total billed charges,37.27% 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,216,40,,172.8,percent of total billed charges,40% of total billed charges,201.26,432,
EP VISIT LEVEL 4,5612353,CDM,510,RC,99214,HCPCS,Outpatient,,,319.68,255.74,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,255.74,80,,204.59,percent of total billed charges,80% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.49,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,96.04,255.74,
NP VISIT LEVEL 4,5612353,CDM,510,RC,99204,HCPCS,Outpatient,,,319.68,255.74,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,255.74,80,,204.59,percent of total billed charges,80% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186.51,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,96.04,255.74,
NP VISIT LEVEL 5,5612353,CDM,510,RC,99205,HCPCS,Outpatient,,,319.68,255.74,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,255.74,80,,204.59,percent of total billed charges,80% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,119.14,37.27,,95.31,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,253.53,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,96.04,255.74,
DIAZEPAM (VALIUM) LV,7000029,CDM,301,RC,80346,HCPCS,Outpatient,,,228.86,183.09,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.09,80,,146.47,percent of total billed charges,80% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% 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,91.54,40,,73.23,percent of total billed charges,40% of total billed charges,85.3,183.09,
CROWNS ALL SIZE,5645742,CDM,270,RC,,,Outpatient,,,33,26.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% 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,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,12.3,26.4,
FENOPROFEN 600MG,6400014,CDM,250,RC,,,Outpatient,,,11.95,9.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.56,80,,7.65,percent of total billed charges,80% of total billed charges,4.45,37.27,,3.56,percent of total billed charges,37.27% of total billed charges,4.45,37.27,,3.56,percent of total billed charges,37.27% of total billed charges,4.45,37.27,,3.56,percent of total billed charges,37.27% 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,4.78,40,,3.82,percent of total billed charges,40% of total billed charges,4.45,9.56,
EZM ENTERO ADM KIT,6000236,CDM,621,RC,,,Outpatient,,,367,293.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,293.6,80,,234.88,percent of total billed charges,80% of total billed charges,136.78,37.27,,109.42,percent of total billed charges,37.27% of total billed charges,136.78,37.27,,109.42,percent of total billed charges,37.27% of total billed charges,136.78,37.27,,109.42,percent of total billed charges,37.27% 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,146.8,40,,117.44,percent of total billed charges,40% of total billed charges,136.78,293.6,
TERAZOSIN 5MG CAP,6400014,CDM,250,RC,,,Outpatient,,,5.45,4.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.36,80,,3.49,percent of total billed charges,80% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% 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,2.18,40,,1.74,percent of total billed charges,40% of total billed charges,2.03,4.36,
PROTEINEX LIQ (OZ),6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
1/2NS 1000ML/KCL 20,5753355,CDM,258,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
PHENYTEK 300MG CAP,6400014,CDM,250,RC,,,Outpatient,,,8.5,6.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.8,80,,5.44,percent of total billed charges,80% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% 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,3.4,40,,2.72,percent of total billed charges,40% of total billed charges,3.17,6.8,
XIFAXAN 200MG TAB,6400014,CDM,250,RC,,,Outpatient,,,89.7,71.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.76,80,,57.41,percent of total billed charges,80% of total billed charges,33.43,37.27,,26.74,percent of total billed charges,37.27% of total billed charges,33.43,37.27,,26.74,percent of total billed charges,37.27% of total billed charges,33.43,37.27,,26.74,percent of total billed charges,37.27% 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,35.88,40,,28.7,percent of total billed charges,40% of total billed charges,33.43,71.76,
HYDROXYUREA 500MG,6400014,CDM,250,RC,,,Outpatient,,,4.35,3.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.48,80,,2.78,percent of total billed charges,80% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% 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,1.74,40,,1.39,percent of total billed charges,40% of total billed charges,1.62,3.48,
ENTOCORT EC 3MG,6400014,CDM,250,RC,,,Outpatient,,,85.6,68.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.48,80,,54.78,percent of total billed charges,80% of total billed charges,31.9,37.27,,25.52,percent of total billed charges,37.27% of total billed charges,31.9,37.27,,25.52,percent of total billed charges,37.27% of total billed charges,31.9,37.27,,25.52,percent of total billed charges,37.27% 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,34.24,40,,27.39,percent of total billed charges,40% of total billed charges,31.9,68.48,
LIDOCAINE/D5W 500ML,6065130,CDM,636,RC,J2001,HCPCS,Outpatient,,,47.9,38.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.32,80,,30.66,percent of total billed charges,80% of total billed charges,17.85,37.27,,14.28,percent of total billed charges,37.27% of total billed charges,17.85,37.27,,14.28,percent of total billed charges,37.27% of total billed charges,17.85,37.27,,14.28,percent of total billed charges,37.27% 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,19.16,40,,15.33,percent of total billed charges,40% of total billed charges,17.85,38.32,
PROCHLORPER.TAB 10MG,6400014,CDM,250,RC,,,Outpatient,,,6.05,4.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,80,,3.87,percent of total billed charges,80% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% 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,2.42,40,,1.94,percent of total billed charges,40% of total billed charges,2.25,4.84,
TIMOLOL 0.5% GFS,6400014,CDM,250,RC,,,Outpatient,,,112.55,90.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.04,80,,72.03,percent of total billed charges,80% of total billed charges,41.95,37.27,,33.56,percent of total billed charges,37.27% of total billed charges,41.95,37.27,,33.56,percent of total billed charges,37.27% of total billed charges,41.95,37.27,,33.56,percent of total billed charges,37.27% 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,45.02,40,,36.02,percent of total billed charges,40% of total billed charges,41.95,90.04,
KETOPROFEN 200MG CAP,6400014,CDM,250,RC,,,Outpatient,,,36.85,29.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.48,80,,23.58,percent of total billed charges,80% of total billed charges,13.73,37.27,,10.98,percent of total billed charges,37.27% of total billed charges,13.73,37.27,,10.98,percent of total billed charges,37.27% of total billed charges,13.73,37.27,,10.98,percent of total billed charges,37.27% 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,14.74,40,,11.79,percent of total billed charges,40% of total billed charges,13.73,29.48,
PROLEX DH LIQUID,6400014,CDM,250,RC,,,Outpatient,,,14.5,11.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.6,80,,9.28,percent of total billed charges,80% of total billed charges,5.4,37.27,,4.32,percent of total billed charges,37.27% of total billed charges,5.4,37.27,,4.32,percent of total billed charges,37.27% of total billed charges,5.4,37.27,,4.32,percent of total billed charges,37.27% 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,5.8,40,,4.64,percent of total billed charges,40% of total billed charges,5.4,11.6,
VIGAMOX 0.5% OPTH,6400014,CDM,250,RC,,,Outpatient,,,608,486.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,486.4,80,,389.12,percent of total billed charges,80% of total billed charges,226.6,37.27,,181.28,percent of total billed charges,37.27% of total billed charges,226.6,37.27,,181.28,percent of total billed charges,37.27% of total billed charges,226.6,37.27,,181.28,percent of total billed charges,37.27% 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,243.2,40,,194.56,percent of total billed charges,40% of total billed charges,226.6,486.4,
NIACIN 500MG TR CAP,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
LUNESTA 2MG TAB,6400014,CDM,250,RC,,,Outpatient,,,79.55,63.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.64,80,,50.91,percent of total billed charges,80% of total billed charges,29.65,37.27,,23.72,percent of total billed charges,37.27% of total billed charges,29.65,37.27,,23.72,percent of total billed charges,37.27% of total billed charges,29.65,37.27,,23.72,percent of total billed charges,37.27% 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,31.82,40,,25.46,percent of total billed charges,40% of total billed charges,29.65,63.64,
OSMOLYTE 1.2CAL CAN,6400014,CDM,250,RC,,,Outpatient,,,8.5,6.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.8,80,,5.44,percent of total billed charges,80% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% 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,3.4,40,,2.72,percent of total billed charges,40% of total billed charges,3.17,6.8,
L-LYSINE 500MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
TAPAZOLE 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,5.4,4.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.32,80,,3.46,percent of total billed charges,80% of total billed charges,2.01,37.27,,1.61,percent of total billed charges,37.27% of total billed charges,2.01,37.27,,1.61,percent of total billed charges,37.27% of total billed charges,2.01,37.27,,1.61,percent of total billed charges,37.27% 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,2.16,40,,1.73,percent of total billed charges,40% of total billed charges,2.01,4.32,
DICLOXACILLIN 500,6400014,CDM,250,RC,,,Outpatient,,,10.65,8.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.52,80,,6.82,percent of total billed charges,80% of total billed charges,3.97,37.27,,3.18,percent of total billed charges,37.27% of total billed charges,3.97,37.27,,3.18,percent of total billed charges,37.27% of total billed charges,3.97,37.27,,3.18,percent of total billed charges,37.27% 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,4.26,40,,3.41,percent of total billed charges,40% of total billed charges,3.97,8.52,
EXCEDRIN ES,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
STRATTERA 25MG CAP,6400014,CDM,250,RC,,,Outpatient,,,53.9,43.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.12,80,,34.5,percent of total billed charges,80% of total billed charges,20.09,37.27,,16.07,percent of total billed charges,37.27% of total billed charges,20.09,37.27,,16.07,percent of total billed charges,37.27% of total billed charges,20.09,37.27,,16.07,percent of total billed charges,37.27% 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,21.56,40,,17.25,percent of total billed charges,40% of total billed charges,20.09,43.12,
PANCURONIUM INJ 2MG/,6400014,CDM,250,RC,,,Outpatient,,,13.55,10.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.84,80,,8.67,percent of total billed charges,80% of total billed charges,5.05,37.27,,4.04,percent of total billed charges,37.27% of total billed charges,5.05,37.27,,4.04,percent of total billed charges,37.27% of total billed charges,5.05,37.27,,4.04,percent of total billed charges,37.27% 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,5.42,40,,4.34,percent of total billed charges,40% of total billed charges,5.05,10.84,
LACRILUBE EYE OINT.,6400014,CDM,250,RC,,,Outpatient,,,38.85,31.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.08,80,,24.86,percent of total billed charges,80% of total billed charges,14.48,37.27,,11.58,percent of total billed charges,37.27% of total billed charges,14.48,37.27,,11.58,percent of total billed charges,37.27% of total billed charges,14.48,37.27,,11.58,percent of total billed charges,37.27% 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,15.54,40,,12.43,percent of total billed charges,40% of total billed charges,14.48,31.08,
SKELAXIN 800MG TAB,6400014,CDM,250,RC,,,Outpatient,,,43.45,34.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.76,80,,27.81,percent of total billed charges,80% of total billed charges,16.19,37.27,,12.95,percent of total billed charges,37.27% of total billed charges,16.19,37.27,,12.95,percent of total billed charges,37.27% of total billed charges,16.19,37.27,,12.95,percent of total billed charges,37.27% 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,17.38,40,,13.9,percent of total billed charges,40% of total billed charges,16.19,34.76,
ENABLEX 7.5MG,6400014,CDM,250,RC,,,Outpatient,,,38.1,30.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.48,80,,24.38,percent of total billed charges,80% of total billed charges,14.2,37.27,,11.36,percent of total billed charges,37.27% of total billed charges,14.2,37.27,,11.36,percent of total billed charges,37.27% of total billed charges,14.2,37.27,,11.36,percent of total billed charges,37.27% 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,15.24,40,,12.19,percent of total billed charges,40% of total billed charges,14.2,30.48,
SCOLIOSIS ERECT 1 V,6000392,CDM,320,RC,72081,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,38.6,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,38.6,264,
NM MYOVIEW,6056246,CDM,340,RC,A9502,HCPCS,Outpatient,,,474,379.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,379.2,80,,303.36,percent of total billed charges,80% of total billed charges,176.66,37.27,,141.33,percent of total billed charges,37.27% of total billed charges,176.66,37.27,,141.33,percent of total billed charges,37.27% of total billed charges,176.66,37.27,,141.33,percent of total billed charges,37.27% 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,189.6,40,,151.68,percent of total billed charges,40% of total billed charges,176.66,379.2,
DIPYRIDAMOLE 10MG,6065130,CDM,636,RC,J1245,HCPCS,Outpatient,,,300,240.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% 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,120,40,,96,percent of total billed charges,40% of total billed charges,111.81,240,
CODEINE 30MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.65,2.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.92,80,,2.34,percent of total billed charges,80% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% 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,1.46,40,,1.17,percent of total billed charges,40% of total billed charges,1.36,2.92,
CARB/LEVODOP CR 25/1,6400014,CDM,250,RC,,,Outpatient,,,3.2,2.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,80,,2.05,percent of total billed charges,80% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% 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,1.28,40,,1.02,percent of total billed charges,40% of total billed charges,1.19,2.56,
IMIPRAMINE 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
DESOXIMETASONE CR .2,6400014,CDM,250,RC,,,Outpatient,,,50.4,40.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,80,,32.26,percent of total billed charges,80% of total billed charges,18.78,37.27,,15.02,percent of total billed charges,37.27% of total billed charges,18.78,37.27,,15.02,percent of total billed charges,37.27% of total billed charges,18.78,37.27,,15.02,percent of total billed charges,37.27% 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,20.16,40,,16.13,percent of total billed charges,40% of total billed charges,18.78,40.32,
VALPROIC ACID 250MG,6400014,CDM,250,RC,,,Outpatient,,,2.7,2.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,80,,1.73,percent of total billed charges,80% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% 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,1.08,40,,0.86,percent of total billed charges,40% of total billed charges,1.01,2.16,
TRICOR 54MG TAB,6400014,CDM,250,RC,,,Outpatient,,,6.8,5.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,80,,4.35,percent of total billed charges,80% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% 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,2.72,40,,2.18,percent of total billed charges,40% of total billed charges,2.53,5.44,
PROPOFOL INJ 100ML,6065130,CDM,636,RC,J2704,HCPCS,Outpatient,,,219.2,175.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.36,80,,140.29,percent of total billed charges,80% of total billed charges,81.7,37.27,,65.36,percent of total billed charges,37.27% of total billed charges,81.7,37.27,,65.36,percent of total billed charges,37.27% of total billed charges,81.7,37.27,,65.36,percent of total billed charges,37.27% 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,87.68,40,,70.14,percent of total billed charges,40% of total billed charges,81.7,175.36,
CELLCEPT500MG PER250,6065130,CDM,636,RC,J7517,HCPCS,Outpatient,,,19,15.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% 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,7.6,40,,6.08,percent of total billed charges,40% of total billed charges,7.08,15.2,
LABETALOL 200MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.45,1.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.96,80,,1.57,percent of total billed charges,80% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% of total billed charges,0.91,37.27,,0.73,percent of total billed charges,37.27% 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,0.98,40,,0.78,percent of total billed charges,40% of total billed charges,0.91,1.96,
ELMIRON 100MG CAP,6400014,CDM,250,RC,,,Outpatient,,,46.2,36.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.96,80,,29.57,percent of total billed charges,80% of total billed charges,17.22,37.27,,13.78,percent of total billed charges,37.27% of total billed charges,17.22,37.27,,13.78,percent of total billed charges,37.27% of total billed charges,17.22,37.27,,13.78,percent of total billed charges,37.27% 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,18.48,40,,14.78,percent of total billed charges,40% of total billed charges,17.22,36.96,
Z-COF LA TAB,6400014,CDM,250,RC,,,Outpatient,,,2.15,1.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.72,80,,1.38,percent of total billed charges,80% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% 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,0.86,40,,0.69,percent of total billed charges,40% of total billed charges,0.8,1.72,
LOCOID CREAM,6400014,CDM,250,RC,,,Outpatient,,,372.9,298.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,298.32,80,,238.66,percent of total billed charges,80% of total billed charges,138.98,37.27,,111.18,percent of total billed charges,37.27% of total billed charges,138.98,37.27,,111.18,percent of total billed charges,37.27% of total billed charges,138.98,37.27,,111.18,percent of total billed charges,37.27% 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,149.16,40,,119.33,percent of total billed charges,40% of total billed charges,138.98,298.32,
TRAVASOL 10% 1000ML,6400014,CDM,250,RC,,,Outpatient,,,326.8,261.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,261.44,80,,209.15,percent of total billed charges,80% of total billed charges,121.8,37.27,,97.44,percent of total billed charges,37.27% of total billed charges,121.8,37.27,,97.44,percent of total billed charges,37.27% of total billed charges,121.8,37.27,,97.44,percent of total billed charges,37.27% 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,130.72,40,,104.58,percent of total billed charges,40% of total billed charges,121.8,261.44,
SOD ACETATE INJ 20ML,6400014,CDM,250,RC,,,Outpatient,,,13.05,10.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.44,80,,8.35,percent of total billed charges,80% of total billed charges,4.86,37.27,,3.89,percent of total billed charges,37.27% of total billed charges,4.86,37.27,,3.89,percent of total billed charges,37.27% of total billed charges,4.86,37.27,,3.89,percent of total billed charges,37.27% 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,5.22,40,,4.18,percent of total billed charges,40% of total billed charges,4.86,10.44,
CYMBALTA 60MG CAP,6400014,CDM,250,RC,,,Outpatient,,,17.6,14.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,80,,11.26,percent of total billed charges,80% of total billed charges,6.56,37.27,,5.25,percent of total billed charges,37.27% of total billed charges,6.56,37.27,,5.25,percent of total billed charges,37.27% of total billed charges,6.56,37.27,,5.25,percent of total billed charges,37.27% 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,7.04,40,,5.63,percent of total billed charges,40% of total billed charges,6.56,14.08,
MESH MARLEX LG,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,452,361.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,361.6,80,,289.28,percent of total billed charges,80% of total billed charges,168.46,37.27,,134.77,percent of total billed charges,37.27% of total billed charges,168.46,37.27,,134.77,percent of total billed charges,37.27% of total billed charges,168.46,37.27,,134.77,percent of total billed charges,37.27% 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,180.8,40,,144.64,percent of total billed charges,40% of total billed charges,168.46,361.6,
US PYLORIC STENOSIS,6000566,CDM,402,RC,76705,HCPCS,Outpatient,,,575,460.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460,80,,368,percent of total billed charges,80% of total billed charges,214.3,37.27,,171.44,percent of total billed charges,37.27% of total billed charges,214.3,37.27,,171.44,percent of total billed charges,37.27% of total billed charges,214.3,37.27,,171.44,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,75.81,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,230,40,,184,percent of total billed charges,40% of total billed charges,75.81,460,
BACTRIM SUSP PER 5ML,6400014,CDM,250,RC,,,Outpatient,,,7.9,6.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.32,80,,5.06,percent of total billed charges,80% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% 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,3.16,40,,2.53,percent of total billed charges,40% of total billed charges,2.94,6.32,
MERCAPTOPURINE 50MG,6400014,CDM,250,RC,,,Outpatient,,,27.9,22.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.32,80,,17.86,percent of total billed charges,80% of total billed charges,10.4,37.27,,8.32,percent of total billed charges,37.27% of total billed charges,10.4,37.27,,8.32,percent of total billed charges,37.27% of total billed charges,10.4,37.27,,8.32,percent of total billed charges,37.27% 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,11.16,40,,8.93,percent of total billed charges,40% of total billed charges,10.4,22.32,
LIMBITROL DS,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
PROLIXIN 25MG/ML,6065130,CDM,636,RC,J2680,HCPCS,Outpatient,,,126.8,101.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.44,80,,81.15,percent of total billed charges,80% of total billed charges,47.26,37.27,,37.81,percent of total billed charges,37.27% of total billed charges,47.26,37.27,,37.81,percent of total billed charges,37.27% of total billed charges,47.26,37.27,,37.81,percent of total billed charges,37.27% 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,50.72,40,,40.58,percent of total billed charges,40% of total billed charges,47.26,101.44,
VERAPAMIL INJ.,6400014,CDM,250,RC,,,Outpatient,,,59.2,47.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.36,80,,37.89,percent of total billed charges,80% of total billed charges,22.06,37.27,,17.65,percent of total billed charges,37.27% of total billed charges,22.06,37.27,,17.65,percent of total billed charges,37.27% of total billed charges,22.06,37.27,,17.65,percent of total billed charges,37.27% 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,23.68,40,,18.94,percent of total billed charges,40% of total billed charges,22.06,47.36,
RELAFEN 750MG TAB,6400014,CDM,250,RC,,,Outpatient,,,8.6,6.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.88,80,,5.5,percent of total billed charges,80% of total billed charges,3.21,37.27,,2.57,percent of total billed charges,37.27% of total billed charges,3.21,37.27,,2.57,percent of total billed charges,37.27% of total billed charges,3.21,37.27,,2.57,percent of total billed charges,37.27% 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,3.44,40,,2.75,percent of total billed charges,40% of total billed charges,3.21,6.88,
AXERT 12.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,98.35,78.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.68,80,,62.94,percent of total billed charges,80% of total billed charges,36.66,37.27,,29.33,percent of total billed charges,37.27% of total billed charges,36.66,37.27,,29.33,percent of total billed charges,37.27% of total billed charges,36.66,37.27,,29.33,percent of total billed charges,37.27% 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,39.34,40,,31.47,percent of total billed charges,40% of total billed charges,36.66,78.68,
IMIPRAMINE 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,4,3.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.2,80,,2.56,percent of total billed charges,80% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% of total billed charges,1.49,37.27,,1.19,percent of total billed charges,37.27% 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,1.6,40,,1.28,percent of total billed charges,40% of total billed charges,1.49,3.2,
TRICOR 145MG TAB,6400014,CDM,250,RC,,,Outpatient,,,23.85,19.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.08,80,,15.26,percent of total billed charges,80% of total billed charges,8.89,37.27,,7.11,percent of total billed charges,37.27% of total billed charges,8.89,37.27,,7.11,percent of total billed charges,37.27% of total billed charges,8.89,37.27,,7.11,percent of total billed charges,37.27% 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,9.54,40,,7.63,percent of total billed charges,40% of total billed charges,8.89,19.08,
LOPERAMIDE LIQ (OZ),6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
OXYTROL 3.9MG PATCH,6400014,CDM,250,RC,,,Outpatient,,,97.9,78.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.32,80,,62.66,percent of total billed charges,80% of total billed charges,36.49,37.27,,29.19,percent of total billed charges,37.27% of total billed charges,36.49,37.27,,29.19,percent of total billed charges,37.27% of total billed charges,36.49,37.27,,29.19,percent of total billed charges,37.27% 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,39.16,40,,31.33,percent of total billed charges,40% of total billed charges,36.49,78.32,
NEULASTA 6MG,6065130,CDM,636,RC,J2506,HCPCS,Outpatient,,,12327.1,9861.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9861.68,80,,7889.34,percent of total billed charges,80% of total billed charges,4594.31,37.27,,3675.45,percent of total billed charges,37.27% of total billed charges,4594.31,37.27,,3675.45,percent of total billed charges,37.27% of total billed charges,4594.31,37.27,,3675.45,percent of total billed charges,37.27% of total billed charges,31.14,100,,,fee schedule,100% of APC rate,31.14,100,,,fee schedule,100% of APC rate,31.14,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,31.14,100,,,fee schedule,100% of APC rate,31.14,100,,,fee schedule,100% of APC rate,31.14,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4930.84,40,,3944.67,percent of total billed charges,40% of total billed charges,31.14,9861.68,
HYDROCODONE/APAP 10/,6400014,CDM,250,RC,,,Outpatient,,,5.5,4.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.4,80,,3.52,percent of total billed charges,80% of total billed charges,2.05,37.27,,1.64,percent of total billed charges,37.27% of total billed charges,2.05,37.27,,1.64,percent of total billed charges,37.27% of total billed charges,2.05,37.27,,1.64,percent of total billed charges,37.27% 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,2.2,40,,1.76,percent of total billed charges,40% of total billed charges,2.05,4.4,
ENSURE PLUS CHOCOLAT,6400014,CDM,250,RC,,,Outpatient,,,7.35,5.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.88,80,,4.7,percent of total billed charges,80% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% of total billed charges,2.74,37.27,,2.19,percent of total billed charges,37.27% 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,2.94,40,,2.35,percent of total billed charges,40% of total billed charges,2.74,5.88,
PROMOD POWDER 275GM,6400014,CDM,250,RC,,,Outpatient,,,39.7,31.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.76,80,,25.41,percent of total billed charges,80% of total billed charges,14.8,37.27,,11.84,percent of total billed charges,37.27% of total billed charges,14.8,37.27,,11.84,percent of total billed charges,37.27% of total billed charges,14.8,37.27,,11.84,percent of total billed charges,37.27% 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,15.88,40,,12.7,percent of total billed charges,40% of total billed charges,14.8,31.76,
NURSERY LEVEL II,56002,CDM,172,RC,,,Inpatient,,,613,490.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,490.4,80,,392.32,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,490.4,490.4,
NAPRELAN-SR 375MG TB,6400014,CDM,250,RC,,,Outpatient,,,7.45,5.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.96,80,,4.77,percent of total billed charges,80% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% 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,2.98,40,,2.38,percent of total billed charges,40% of total billed charges,2.78,5.96,
PHENYLGESIC TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
GEODON 80MG CAP,6400014,CDM,250,RC,,,Outpatient,,,37.8,30.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.24,80,,24.19,percent of total billed charges,80% of total billed charges,14.09,37.27,,11.27,percent of total billed charges,37.27% of total billed charges,14.09,37.27,,11.27,percent of total billed charges,37.27% of total billed charges,14.09,37.27,,11.27,percent of total billed charges,37.27% 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,15.12,40,,12.1,percent of total billed charges,40% of total billed charges,14.09,30.24,
PHENYTEK 200MG CAP,6400014,CDM,250,RC,,,Outpatient,,,5.7,4.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.56,80,,3.65,percent of total billed charges,80% of total billed charges,2.12,37.27,,1.7,percent of total billed charges,37.27% of total billed charges,2.12,37.27,,1.7,percent of total billed charges,37.27% of total billed charges,2.12,37.27,,1.7,percent of total billed charges,37.27% 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,2.28,40,,1.82,percent of total billed charges,40% of total billed charges,2.12,4.56,
REQUIP 0.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,10.5,8.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,80,,6.72,percent of total billed charges,80% of total billed charges,3.91,37.27,,3.13,percent of total billed charges,37.27% of total billed charges,3.91,37.27,,3.13,percent of total billed charges,37.27% of total billed charges,3.91,37.27,,3.13,percent of total billed charges,37.27% 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,4.2,40,,3.36,percent of total billed charges,40% of total billed charges,3.91,8.4,
FISH OIL 1000MG CAP,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
FLOXIN OTIC 5ML,6400014,CDM,250,RC,,,Outpatient,,,402.65,322.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,322.12,80,,257.7,percent of total billed charges,80% of total billed charges,150.07,37.27,,120.06,percent of total billed charges,37.27% of total billed charges,150.07,37.27,,120.06,percent of total billed charges,37.27% of total billed charges,150.07,37.27,,120.06,percent of total billed charges,37.27% 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,161.06,40,,128.85,percent of total billed charges,40% of total billed charges,150.07,322.12,
CORTROSYN 0.25MG IJ,6065130,CDM,636,RC,J0834,HCPCS,Outpatient,,,439.6,351.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,351.68,80,,281.34,percent of total billed charges,80% of total billed charges,163.84,37.27,,131.07,percent of total billed charges,37.27% of total billed charges,163.84,37.27,,131.07,percent of total billed charges,37.27% of total billed charges,163.84,37.27,,131.07,percent of total billed charges,37.27% 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,175.84,40,,140.67,percent of total billed charges,40% of total billed charges,163.84,351.68,
MIOCHOL-E OPTH SOLN,6400014,CDM,250,RC,,,Outpatient,,,163.45,130.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.76,80,,104.61,percent of total billed charges,80% of total billed charges,60.92,37.27,,48.74,percent of total billed charges,37.27% of total billed charges,60.92,37.27,,48.74,percent of total billed charges,37.27% of total billed charges,60.92,37.27,,48.74,percent of total billed charges,37.27% 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,65.38,40,,52.3,percent of total billed charges,40% of total billed charges,60.92,130.76,
AVANDAMET 1-500 TAB,6400014,CDM,250,RC,,,Outpatient,,,4.8,3.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.84,80,,3.07,percent of total billed charges,80% of total billed charges,1.79,37.27,,1.43,percent of total billed charges,37.27% of total billed charges,1.79,37.27,,1.43,percent of total billed charges,37.27% of total billed charges,1.79,37.27,,1.43,percent of total billed charges,37.27% 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,1.92,40,,1.54,percent of total billed charges,40% of total billed charges,1.79,3.84,
BACTRIM INJ 10ML,6400014,CDM,250,RC,,,Outpatient,,,821.1,656.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,656.88,80,,525.5,percent of total billed charges,80% of total billed charges,306.02,37.27,,244.82,percent of total billed charges,37.27% of total billed charges,306.02,37.27,,244.82,percent of total billed charges,37.27% of total billed charges,306.02,37.27,,244.82,percent of total billed charges,37.27% 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,328.44,40,,262.75,percent of total billed charges,40% of total billed charges,306.02,656.88,
AROMASIN 25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,80.2,64.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.16,80,,51.33,percent of total billed charges,80% of total billed charges,29.89,37.27,,23.91,percent of total billed charges,37.27% of total billed charges,29.89,37.27,,23.91,percent of total billed charges,37.27% of total billed charges,29.89,37.27,,23.91,percent of total billed charges,37.27% 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,32.08,40,,25.66,percent of total billed charges,40% of total billed charges,29.89,64.16,
AYR SALINE NASAL GEL,6400014,CDM,250,RC,,,Outpatient,,,13.4,10.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.72,80,,8.58,percent of total billed charges,80% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% 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,5.36,40,,4.29,percent of total billed charges,40% of total billed charges,4.99,10.72,
HCV FIBROSURE,7012032,CDM,300,RC,,,Outpatient,,,256,204.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.8,80,,163.84,percent of total billed charges,80% of total billed charges,95.41,37.27,,76.33,percent of total billed charges,37.27% of total billed charges,95.41,37.27,,76.33,percent of total billed charges,37.27% of total billed charges,95.41,37.27,,76.33,percent of total billed charges,37.27% 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,102.4,40,,81.92,percent of total billed charges,40% of total billed charges,95.41,204.8,
KAO-TIM PER 30ML,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
RENAGEL 800MG CAP,6400014,CDM,250,RC,,,Outpatient,,,30.4,24.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.32,80,,19.46,percent of total billed charges,80% of total billed charges,11.33,37.27,,9.06,percent of total billed charges,37.27% of total billed charges,11.33,37.27,,9.06,percent of total billed charges,37.27% of total billed charges,11.33,37.27,,9.06,percent of total billed charges,37.27% 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,12.16,40,,9.73,percent of total billed charges,40% of total billed charges,11.33,24.32,
DORYX 75MG,6400014,CDM,250,RC,,,Outpatient,,,16.8,13.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.44,80,,10.75,percent of total billed charges,80% of total billed charges,6.26,37.27,,5.01,percent of total billed charges,37.27% of total billed charges,6.26,37.27,,5.01,percent of total billed charges,37.27% of total billed charges,6.26,37.27,,5.01,percent of total billed charges,37.27% 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,6.72,40,,5.38,percent of total billed charges,40% of total billed charges,6.26,13.44,
GLUCOSAMINE 500MG CA,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
VAGIFEM 25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,157.7,126.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.16,80,,100.93,percent of total billed charges,80% of total billed charges,58.77,37.27,,47.02,percent of total billed charges,37.27% of total billed charges,58.77,37.27,,47.02,percent of total billed charges,37.27% of total billed charges,58.77,37.27,,47.02,percent of total billed charges,37.27% 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,63.08,40,,50.46,percent of total billed charges,40% of total billed charges,58.77,126.16,
PREVACID 30MG SOLTB,6400014,CDM,250,RC,,,Outpatient,,,25.35,20.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.28,80,,16.22,percent of total billed charges,80% of total billed charges,9.45,37.27,,7.56,percent of total billed charges,37.27% of total billed charges,9.45,37.27,,7.56,percent of total billed charges,37.27% of total billed charges,9.45,37.27,,7.56,percent of total billed charges,37.27% 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,10.14,40,,8.11,percent of total billed charges,40% of total billed charges,9.45,20.28,
RESTASIS DROPS,6400014,CDM,250,RC,,,Outpatient,,,44,35.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% 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,17.6,40,,14.08,percent of total billed charges,40% of total billed charges,16.4,35.2,
METHOTREXATE 2.5 TAB,6400014,CDM,250,RC,,,Outpatient,,,21.25,17.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17,80,,13.6,percent of total billed charges,80% of total billed charges,7.92,37.27,,6.34,percent of total billed charges,37.27% of total billed charges,7.92,37.27,,6.34,percent of total billed charges,37.27% of total billed charges,7.92,37.27,,6.34,percent of total billed charges,37.27% 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,8.5,40,,6.8,percent of total billed charges,40% of total billed charges,7.92,17,
ORTHO EVRA PATCH,6400014,CDM,250,RC,,,Outpatient,,,51.91,41.53,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.53,80,,33.22,percent of total billed charges,80% of total billed charges,19.35,37.27,,15.48,percent of total billed charges,37.27% of total billed charges,19.35,37.27,,15.48,percent of total billed charges,37.27% of total billed charges,19.35,37.27,,15.48,percent of total billed charges,37.27% 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,20.76,40,,16.61,percent of total billed charges,40% of total billed charges,19.35,41.53,
UROXATRAL 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,50.4,40.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.32,80,,32.26,percent of total billed charges,80% of total billed charges,18.78,37.27,,15.02,percent of total billed charges,37.27% of total billed charges,18.78,37.27,,15.02,percent of total billed charges,37.27% of total billed charges,18.78,37.27,,15.02,percent of total billed charges,37.27% 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,20.16,40,,16.13,percent of total billed charges,40% of total billed charges,18.78,40.32,
VIVELLE 0.0375MG,6400014,CDM,250,RC,,,Outpatient,,,14.1,11.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.28,80,,9.02,percent of total billed charges,80% of total billed charges,5.26,37.27,,4.21,percent of total billed charges,37.27% of total billed charges,5.26,37.27,,4.21,percent of total billed charges,37.27% of total billed charges,5.26,37.27,,4.21,percent of total billed charges,37.27% 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,5.64,40,,4.51,percent of total billed charges,40% of total billed charges,5.26,11.28,
TRILISATE 1000MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.85,2.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,80,,1.82,percent of total billed charges,80% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% 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,1.14,40,,0.91,percent of total billed charges,40% of total billed charges,1.06,2.28,
RIDAURA 3MG CAP,6400014,CDM,250,RC,,,Outpatient,,,97.1,77.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.68,80,,62.14,percent of total billed charges,80% of total billed charges,36.19,37.27,,28.95,percent of total billed charges,37.27% of total billed charges,36.19,37.27,,28.95,percent of total billed charges,37.27% of total billed charges,36.19,37.27,,28.95,percent of total billed charges,37.27% 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,38.84,40,,31.07,percent of total billed charges,40% of total billed charges,36.19,77.68,
TYSABRI 300MG/15ML,6065130,CDM,636,RC,J2323,HCPCS,Outpatient,,,12914.05,10331.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10331.24,80,,8264.99,percent of total billed charges,80% of total billed charges,4813.07,37.27,,3850.46,percent of total billed charges,37.27% of total billed charges,4813.07,37.27,,3850.46,percent of total billed charges,37.27% of total billed charges,4813.07,37.27,,3850.46,percent of total billed charges,37.27% of total billed charges,24.15,100,,,fee schedule,100% of APC rate,24.15,100,,,fee schedule,100% of APC rate,24.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,24.15,100,,,fee schedule,100% of APC rate,24.15,100,,,fee schedule,100% of APC rate,24.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5165.62,40,,4132.5,percent of total billed charges,40% of total billed charges,24.15,10331.24,
US UMBILICAL ARTERY,6000566,CDM,402,RC,76820,HCPCS,Outpatient,,,720,576.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,27.19,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,40,,230.4,percent of total billed charges,40% of total billed charges,27.19,576,
PANNAZ S SYRUP,6400014,CDM,250,RC,,,Outpatient,,,11.2,8.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,80,,7.17,percent of total billed charges,80% of total billed charges,4.17,37.27,,3.34,percent of total billed charges,37.27% of total billed charges,4.17,37.27,,3.34,percent of total billed charges,37.27% of total billed charges,4.17,37.27,,3.34,percent of total billed charges,37.27% 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,4.48,40,,3.58,percent of total billed charges,40% of total billed charges,4.17,8.96,
ESTRATEST HS TABLET,6400014,CDM,250,RC,,,Outpatient,,,16.3,13.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.04,80,,10.43,percent of total billed charges,80% of total billed charges,6.08,37.27,,4.86,percent of total billed charges,37.27% of total billed charges,6.08,37.27,,4.86,percent of total billed charges,37.27% of total billed charges,6.08,37.27,,4.86,percent of total billed charges,37.27% 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,6.52,40,,5.22,percent of total billed charges,40% of total billed charges,6.08,13.04,
MIRAPEX 1MG TAB,6400014,CDM,250,RC,,,Outpatient,,,8.95,7.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.16,80,,5.73,percent of total billed charges,80% of total billed charges,3.34,37.27,,2.67,percent of total billed charges,37.27% of total billed charges,3.34,37.27,,2.67,percent of total billed charges,37.27% of total billed charges,3.34,37.27,,2.67,percent of total billed charges,37.27% 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,3.58,40,,2.86,percent of total billed charges,40% of total billed charges,3.34,7.16,
PINDOLOL 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,4.45,3.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.56,80,,2.85,percent of total billed charges,80% of total billed charges,1.66,37.27,,1.33,percent of total billed charges,37.27% of total billed charges,1.66,37.27,,1.33,percent of total billed charges,37.27% of total billed charges,1.66,37.27,,1.33,percent of total billed charges,37.27% 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,1.78,40,,1.42,percent of total billed charges,40% of total billed charges,1.66,3.56,
ROBITUSSIN COUGH GEL,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
DUONEB 3ML,6400014,CDM,250,RC,,,Outpatient,,,7.5,6.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,80,,4.8,percent of total billed charges,80% of total billed charges,2.8,37.27,,2.24,percent of total billed charges,37.27% of total billed charges,2.8,37.27,,2.24,percent of total billed charges,37.27% of total billed charges,2.8,37.27,,2.24,percent of total billed charges,37.27% 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,3,40,,2.4,percent of total billed charges,40% of total billed charges,2.8,6,
ISONIAZID 100MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
EPIPEN JR 0.15MG/0.3,6065130,CDM,636,RC,J0171,HCPCS,Outpatient,,,639.35,511.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,511.48,80,,409.18,percent of total billed charges,80% of total billed charges,238.29,37.27,,190.63,percent of total billed charges,37.27% of total billed charges,238.29,37.27,,190.63,percent of total billed charges,37.27% of total billed charges,238.29,37.27,,190.63,percent of total billed charges,37.27% 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,255.74,40,,204.59,percent of total billed charges,40% of total billed charges,238.29,511.48,
FLETCHERS CASTORIA,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
HYZAAR 100-25 TAB,6400014,CDM,250,RC,,,Outpatient,,,20.35,16.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.28,80,,13.02,percent of total billed charges,80% of total billed charges,7.58,37.27,,6.06,percent of total billed charges,37.27% of total billed charges,7.58,37.27,,6.06,percent of total billed charges,37.27% of total billed charges,7.58,37.27,,6.06,percent of total billed charges,37.27% 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,8.14,40,,6.51,percent of total billed charges,40% of total billed charges,7.58,16.28,
GLUCOSE 6 PD PANEL,7012032,CDM,300,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
SCRUB SAFE KNIFE PAN,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
TRIAMCINOLONE .025%,6400014,CDM,250,RC,,,Outpatient,,,17.33,13.86,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.86,80,,11.09,percent of total billed charges,80% of total billed charges,6.46,37.27,,5.17,percent of total billed charges,37.27% of total billed charges,6.46,37.27,,5.17,percent of total billed charges,37.27% of total billed charges,6.46,37.27,,5.17,percent of total billed charges,37.27% 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,6.93,40,,5.54,percent of total billed charges,40% of total billed charges,6.46,13.86,
KETOCONAZOLE CR 15GM,6400014,CDM,250,RC,,,Outpatient,,,28.1,22.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.48,80,,17.98,percent of total billed charges,80% of total billed charges,10.47,37.27,,8.38,percent of total billed charges,37.27% of total billed charges,10.47,37.27,,8.38,percent of total billed charges,37.27% of total billed charges,10.47,37.27,,8.38,percent of total billed charges,37.27% 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,11.24,40,,8.99,percent of total billed charges,40% of total billed charges,10.47,22.48,
RAZADYNE ER 24MG,6400014,CDM,250,RC,,,Outpatient,,,64.3,51.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.44,80,,41.15,percent of total billed charges,80% of total billed charges,23.96,37.27,,19.17,percent of total billed charges,37.27% of total billed charges,23.96,37.27,,19.17,percent of total billed charges,37.27% of total billed charges,23.96,37.27,,19.17,percent of total billed charges,37.27% 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,25.72,40,,20.58,percent of total billed charges,40% of total billed charges,23.96,51.44,
CATH WORD,5645742,CDM,270,RC,,,Outpatient,,,103,82.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% 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,41.2,40,,32.96,percent of total billed charges,40% of total billed charges,38.39,82.4,
TYGACIL INJ 50MG,6065130,CDM,636,RC,J3243,HCPCS,Outpatient,,,650.05,520.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520.04,80,,416.03,percent of total billed charges,80% of total billed charges,242.27,37.27,,193.82,percent of total billed charges,37.27% of total billed charges,242.27,37.27,,193.82,percent of total billed charges,37.27% of total billed charges,242.27,37.27,,193.82,percent of total billed charges,37.27% 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,260.02,40,,208.02,percent of total billed charges,40% of total billed charges,242.27,520.04,
VAP LIPOPROTEI PANEL,7012032,CDM,300,RC,,,Outpatient,,,32,25.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,80,,20.48,percent of total billed charges,80% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% of total billed charges,11.93,37.27,,9.54,percent of total billed charges,37.27% 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,12.8,40,,10.24,percent of total billed charges,40% of total billed charges,11.93,25.6,
HURRICAINE SPRAY,6400014,CDM,250,RC,,,Outpatient,,,75.6,60.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.48,80,,48.38,percent of total billed charges,80% of total billed charges,28.18,37.27,,22.54,percent of total billed charges,37.27% of total billed charges,28.18,37.27,,22.54,percent of total billed charges,37.27% of total billed charges,28.18,37.27,,22.54,percent of total billed charges,37.27% 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,30.24,40,,24.19,percent of total billed charges,40% of total billed charges,28.18,60.48,
PENTASA 500MG CAP,6400014,CDM,250,RC,,,Outpatient,,,24.8,19.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.84,80,,15.87,percent of total billed charges,80% of total billed charges,9.24,37.27,,7.39,percent of total billed charges,37.27% of total billed charges,9.24,37.27,,7.39,percent of total billed charges,37.27% of total billed charges,9.24,37.27,,7.39,percent of total billed charges,37.27% 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,9.92,40,,7.94,percent of total billed charges,40% of total billed charges,9.24,19.84,
TROPICAMIDE 1% 3ML,6400014,CDM,250,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
ANAMANTLE HC CR (EA),6400014,CDM,250,RC,,,Outpatient,,,68,54.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,80,,43.52,percent of total billed charges,80% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% of total billed charges,25.34,37.27,,20.27,percent of total billed charges,37.27% 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,27.2,40,,21.76,percent of total billed charges,40% of total billed charges,25.34,54.4,
VERAPAMIL SR 180 TAB,6400014,CDM,250,RC,,,Outpatient,,,9.2,7.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.36,80,,5.89,percent of total billed charges,80% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% of total billed charges,3.43,37.27,,2.74,percent of total billed charges,37.27% 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,3.68,40,,2.94,percent of total billed charges,40% of total billed charges,3.43,7.36,
EDECRIN 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.75,1.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.4,80,,1.12,percent of total billed charges,80% of total billed charges,0.65,37.27,,0.52,percent of total billed charges,37.27% of total billed charges,0.65,37.27,,0.52,percent of total billed charges,37.27% of total billed charges,0.65,37.27,,0.52,percent of total billed charges,37.27% 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,0.7,40,,0.56,percent of total billed charges,40% of total billed charges,0.65,1.4,
CANASA SUPP 500MG,6400014,CDM,250,RC,,,Outpatient,,,18.45,14.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.76,80,,11.81,percent of total billed charges,80% of total billed charges,6.88,37.27,,5.5,percent of total billed charges,37.27% of total billed charges,6.88,37.27,,5.5,percent of total billed charges,37.27% of total billed charges,6.88,37.27,,5.5,percent of total billed charges,37.27% 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,7.38,40,,5.9,percent of total billed charges,40% of total billed charges,6.88,14.76,
EDECRIN 25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,16.05,12.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.84,80,,10.27,percent of total billed charges,80% of total billed charges,5.98,37.27,,4.78,percent of total billed charges,37.27% of total billed charges,5.98,37.27,,4.78,percent of total billed charges,37.27% of total billed charges,5.98,37.27,,4.78,percent of total billed charges,37.27% 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,6.42,40,,5.14,percent of total billed charges,40% of total billed charges,5.98,12.84,
ETODOLAC 300MG,6400014,CDM,250,RC,,,Outpatient,,,5.5,4.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.4,80,,3.52,percent of total billed charges,80% of total billed charges,2.05,37.27,,1.64,percent of total billed charges,37.27% of total billed charges,2.05,37.27,,1.64,percent of total billed charges,37.27% of total billed charges,2.05,37.27,,1.64,percent of total billed charges,37.27% 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,2.2,40,,1.76,percent of total billed charges,40% of total billed charges,2.05,4.4,
ETODOLAC 400MG,6400014,CDM,250,RC,,,Outpatient,,,4.95,3.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.96,80,,3.17,percent of total billed charges,80% of total billed charges,1.84,37.27,,1.47,percent of total billed charges,37.27% of total billed charges,1.84,37.27,,1.47,percent of total billed charges,37.27% of total billed charges,1.84,37.27,,1.47,percent of total billed charges,37.27% 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,1.98,40,,1.58,percent of total billed charges,40% of total billed charges,1.84,3.96,
GLUCERNA SHAKE,6400014,CDM,250,RC,,,Outpatient,,,7.25,5.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.8,80,,4.64,percent of total billed charges,80% of total billed charges,2.7,37.27,,2.16,percent of total billed charges,37.27% of total billed charges,2.7,37.27,,2.16,percent of total billed charges,37.27% of total billed charges,2.7,37.27,,2.16,percent of total billed charges,37.27% 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,2.9,40,,2.32,percent of total billed charges,40% of total billed charges,2.7,5.8,
FLUOXETINE SOLN.,6400014,CDM,250,RC,,,Outpatient,,,104.85,83.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.88,80,,67.1,percent of total billed charges,80% of total billed charges,39.08,37.27,,31.26,percent of total billed charges,37.27% of total billed charges,39.08,37.27,,31.26,percent of total billed charges,37.27% of total billed charges,39.08,37.27,,31.26,percent of total billed charges,37.27% 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,41.94,40,,33.55,percent of total billed charges,40% of total billed charges,39.08,83.88,
IV INF THERAPY INT,5811182,CDM,260,RC,96365,HCPCS,Outpatient,,,526,420.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.8,80,,336.64,percent of total billed charges,80% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,81.26,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,40,,168.32,percent of total billed charges,40% of total billed charges,81.26,420.8,
IV INF THER ADD HRS,5811182,CDM,260,RC,96366,HCPCS,Outpatient,,,123,98.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,26.98,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,40,,39.36,percent of total billed charges,40% of total billed charges,26.98,98.4,
ARANESP 300INJ(PER5),6065130,CDM,636,RC,J0881,HCPCS,Outpatient,,,65.78,52.62,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.62,80,,42.1,percent of total billed charges,80% of total billed charges,24.52,37.27,,19.62,percent of total billed charges,37.27% of total billed charges,24.52,37.27,,19.62,percent of total billed charges,37.27% of total billed charges,24.52,37.27,,19.62,percent of total billed charges,37.27% of total billed charges,3.04,100,,,fee schedule,100% of APC rate,3.04,100,,,fee schedule,100% of APC rate,3.04,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,3.04,100,,,fee schedule,100% of APC rate,3.04,100,,,fee schedule,100% of APC rate,3.04,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.31,40,,21.05,percent of total billed charges,40% of total billed charges,3.04,52.62,
ALLFEN DM TAB,6400014,CDM,250,RC,,,Outpatient,,,3.8,3.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.04,80,,2.43,percent of total billed charges,80% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% 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,1.52,40,,1.22,percent of total billed charges,40% of total billed charges,1.42,3.04,
GLEEVEC 400MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1174.2,939.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,939.36,80,,751.49,percent of total billed charges,80% of total billed charges,437.62,37.27,,350.1,percent of total billed charges,37.27% of total billed charges,437.62,37.27,,350.1,percent of total billed charges,37.27% of total billed charges,437.62,37.27,,350.1,percent of total billed charges,37.27% 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,469.68,40,,375.74,percent of total billed charges,40% of total billed charges,437.62,939.36,
METHAZOLAMIDE 50MG,6400014,CDM,250,RC,,,Outpatient,,,26.1,20.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.88,80,,16.7,percent of total billed charges,80% of total billed charges,9.73,37.27,,7.78,percent of total billed charges,37.27% of total billed charges,9.73,37.27,,7.78,percent of total billed charges,37.27% of total billed charges,9.73,37.27,,7.78,percent of total billed charges,37.27% 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,10.44,40,,8.35,percent of total billed charges,40% of total billed charges,9.73,20.88,
LYRICA 75MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,44.45,35.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.56,80,,28.45,percent of total billed charges,80% of total billed charges,16.57,37.27,,13.26,percent of total billed charges,37.27% of total billed charges,16.57,37.27,,13.26,percent of total billed charges,37.27% of total billed charges,16.57,37.27,,13.26,percent of total billed charges,37.27% 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,17.78,40,,14.22,percent of total billed charges,40% of total billed charges,16.57,35.56,
BIDIL TAB,6400014,CDM,250,RC,,,Outpatient,,,15.7,12.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,80,,10.05,percent of total billed charges,80% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% 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,6.28,40,,5.02,percent of total billed charges,40% of total billed charges,5.85,12.56,
FLUOCIN-.025% CR 60G,6400014,CDM,250,RC,,,Outpatient,,,23.8,19.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.04,80,,15.23,percent of total billed charges,80% of total billed charges,8.87,37.27,,7.1,percent of total billed charges,37.27% of total billed charges,8.87,37.27,,7.1,percent of total billed charges,37.27% of total billed charges,8.87,37.27,,7.1,percent of total billed charges,37.27% 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,9.52,40,,7.62,percent of total billed charges,40% of total billed charges,8.87,19.04,
DEXAMETH 0.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CT NECK (WO),6010052,CDM,350,RC,70490,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,118.93,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,90.64,1316,
CRANBERRY CAP,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CETAPHIL LOTION 16OZ,6400014,CDM,250,RC,,,Outpatient,,,34.35,27.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.48,80,,21.98,percent of total billed charges,80% of total billed charges,12.8,37.27,,10.24,percent of total billed charges,37.27% of total billed charges,12.8,37.27,,10.24,percent of total billed charges,37.27% of total billed charges,12.8,37.27,,10.24,percent of total billed charges,37.27% 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,13.74,40,,10.99,percent of total billed charges,40% of total billed charges,12.8,27.48,
TOPAMAX 15MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,8.85,7.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.08,80,,5.66,percent of total billed charges,80% of total billed charges,3.3,37.27,,2.64,percent of total billed charges,37.27% of total billed charges,3.3,37.27,,2.64,percent of total billed charges,37.27% of total billed charges,3.3,37.27,,2.64,percent of total billed charges,37.27% 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,3.54,40,,2.83,percent of total billed charges,40% of total billed charges,3.3,7.08,
ACEBUTOLOL 200MG,6400014,CDM,250,RC,,,Outpatient,,,6.05,4.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,80,,3.87,percent of total billed charges,80% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% 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,2.42,40,,1.94,percent of total billed charges,40% of total billed charges,2.25,4.84,
HOMOVANILLIC PANEL,7012032,CDM,300,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
ARIMIDEX 1MG TAB,6400014,CDM,250,RC,,,Outpatient,,,58.8,47.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.04,80,,37.63,percent of total billed charges,80% of total billed charges,21.91,37.27,,17.53,percent of total billed charges,37.27% of total billed charges,21.91,37.27,,17.53,percent of total billed charges,37.27% of total billed charges,21.91,37.27,,17.53,percent of total billed charges,37.27% 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,23.52,40,,18.82,percent of total billed charges,40% of total billed charges,21.91,47.04,
ZIOX OINTMENT 30GM,6400014,CDM,250,RC,,,Outpatient,,,263.85,211.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.08,80,,168.86,percent of total billed charges,80% of total billed charges,98.34,37.27,,78.67,percent of total billed charges,37.27% of total billed charges,98.34,37.27,,78.67,percent of total billed charges,37.27% of total billed charges,98.34,37.27,,78.67,percent of total billed charges,37.27% 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,105.54,40,,84.43,percent of total billed charges,40% of total billed charges,98.34,211.08,
FLOVENT HFA 110MCG,6400014,CDM,250,RC,,,Outpatient,,,857.6,686.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,686.08,80,,548.86,percent of total billed charges,80% of total billed charges,319.63,37.27,,255.7,percent of total billed charges,37.27% of total billed charges,319.63,37.27,,255.7,percent of total billed charges,37.27% of total billed charges,319.63,37.27,,255.7,percent of total billed charges,37.27% 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,343.04,40,,274.43,percent of total billed charges,40% of total billed charges,319.63,686.08,
CLOMIPRAMINE 25MG CA,6400014,CDM,250,RC,,,Outpatient,,,38.3,30.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.64,80,,24.51,percent of total billed charges,80% of total billed charges,14.27,37.27,,11.42,percent of total billed charges,37.27% of total billed charges,14.27,37.27,,11.42,percent of total billed charges,37.27% of total billed charges,14.27,37.27,,11.42,percent of total billed charges,37.27% 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,15.32,40,,12.26,percent of total billed charges,40% of total billed charges,14.27,30.64,
ACEON 4MG TAB,6400014,CDM,250,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
DIPYRIDAMOLE 10MG IJ,6065130,CDM,636,RC,J1245,HCPCS,Outpatient,,,28.45,22.76,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.76,80,,18.21,percent of total billed charges,80% of total billed charges,10.6,37.27,,8.48,percent of total billed charges,37.27% of total billed charges,10.6,37.27,,8.48,percent of total billed charges,37.27% of total billed charges,10.6,37.27,,8.48,percent of total billed charges,37.27% 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,11.38,40,,9.1,percent of total billed charges,40% of total billed charges,10.6,22.76,
DOSTINEX 0.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,115.25,92.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.2,80,,73.76,percent of total billed charges,80% of total billed charges,42.95,37.27,,34.36,percent of total billed charges,37.27% of total billed charges,42.95,37.27,,34.36,percent of total billed charges,37.27% of total billed charges,42.95,37.27,,34.36,percent of total billed charges,37.27% 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,46.1,40,,36.88,percent of total billed charges,40% of total billed charges,42.95,92.2,
HEMOCYTE F ELIXIR,6400014,CDM,250,RC,,,Outpatient,,,13.75,11.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11,80,,8.8,percent of total billed charges,80% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% 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,5.5,40,,4.4,percent of total billed charges,40% of total billed charges,5.12,11,
POLY HIST FORTE,6400014,CDM,250,RC,,,Outpatient,,,2.75,2.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.2,80,,1.76,percent of total billed charges,80% of total billed charges,1.02,37.27,,0.82,percent of total billed charges,37.27% of total billed charges,1.02,37.27,,0.82,percent of total billed charges,37.27% of total billed charges,1.02,37.27,,0.82,percent of total billed charges,37.27% 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,1.1,40,,0.88,percent of total billed charges,40% of total billed charges,1.02,2.2,
ZEPHIRAN SOLUTION,6400014,CDM,250,RC,,,Outpatient,,,53.43,42.74,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.74,80,,34.19,percent of total billed charges,80% of total billed charges,19.91,37.27,,15.93,percent of total billed charges,37.27% of total billed charges,19.91,37.27,,15.93,percent of total billed charges,37.27% of total billed charges,19.91,37.27,,15.93,percent of total billed charges,37.27% 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,21.37,40,,17.1,percent of total billed charges,40% of total billed charges,19.91,42.74,
TEGRETOL XR 200MG,6400014,CDM,250,RC,,,Outpatient,,,13.15,10.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.52,80,,8.42,percent of total billed charges,80% of total billed charges,4.9,37.27,,3.92,percent of total billed charges,37.27% of total billed charges,4.9,37.27,,3.92,percent of total billed charges,37.27% of total billed charges,4.9,37.27,,3.92,percent of total billed charges,37.27% 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,5.26,40,,4.21,percent of total billed charges,40% of total billed charges,4.9,10.52,
ALKERAN TAB 2MG,6400014,CDM,250,RC,,,Outpatient,,,26.5,21.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.2,80,,16.96,percent of total billed charges,80% of total billed charges,9.88,37.27,,7.9,percent of total billed charges,37.27% of total billed charges,9.88,37.27,,7.9,percent of total billed charges,37.27% of total billed charges,9.88,37.27,,7.9,percent of total billed charges,37.27% 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,10.6,40,,8.48,percent of total billed charges,40% of total billed charges,9.88,21.2,
CLOZARIL TAB 100MG,6400014,CDM,250,RC,,,Outpatient,,,21.1,16.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.88,80,,13.5,percent of total billed charges,80% of total billed charges,7.86,37.27,,6.29,percent of total billed charges,37.27% of total billed charges,7.86,37.27,,6.29,percent of total billed charges,37.27% of total billed charges,7.86,37.27,,6.29,percent of total billed charges,37.27% 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,8.44,40,,6.75,percent of total billed charges,40% of total billed charges,7.86,16.88,
LYRICA 50MG CAP,6400014,CDM,250,RC,,,Outpatient,,,40.4,32.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,80,,25.86,percent of total billed charges,80% of total billed charges,15.06,37.27,,12.05,percent of total billed charges,37.27% of total billed charges,15.06,37.27,,12.05,percent of total billed charges,37.27% of total billed charges,15.06,37.27,,12.05,percent of total billed charges,37.27% 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,16.16,40,,12.93,percent of total billed charges,40% of total billed charges,15.06,32.32,
LAMICTAL 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,58.5,46.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.8,80,,37.44,percent of total billed charges,80% of total billed charges,21.8,37.27,,17.44,percent of total billed charges,37.27% of total billed charges,21.8,37.27,,17.44,percent of total billed charges,37.27% of total billed charges,21.8,37.27,,17.44,percent of total billed charges,37.27% 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,23.4,40,,18.72,percent of total billed charges,40% of total billed charges,21.8,46.8,
FELBATOL 600MG TAB,6400014,CDM,250,RC,,,Outpatient,,,27.55,22.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.04,80,,17.63,percent of total billed charges,80% of total billed charges,10.27,37.27,,8.22,percent of total billed charges,37.27% of total billed charges,10.27,37.27,,8.22,percent of total billed charges,37.27% of total billed charges,10.27,37.27,,8.22,percent of total billed charges,37.27% 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,11.02,40,,8.82,percent of total billed charges,40% of total billed charges,10.27,22.04,
CYTOMEGALOVIRU PANEL,7012032,CDM,300,RC,,,Outpatient,,,173,138.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% 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,69.2,40,,55.36,percent of total billed charges,40% of total billed charges,64.48,138.4,
DISOPYRAMIDE 150MG C,6400014,CDM,250,RC,,,Outpatient,,,5.55,4.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.44,80,,3.55,percent of total billed charges,80% of total billed charges,2.07,37.27,,1.66,percent of total billed charges,37.27% of total billed charges,2.07,37.27,,1.66,percent of total billed charges,37.27% of total billed charges,2.07,37.27,,1.66,percent of total billed charges,37.27% 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,2.22,40,,1.78,percent of total billed charges,40% of total billed charges,2.07,4.44,
RAZADYNE ER 16 CAP,6400014,CDM,250,RC,,,Outpatient,,,25.95,20.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.76,80,,16.61,percent of total billed charges,80% of total billed charges,9.67,37.27,,7.74,percent of total billed charges,37.27% of total billed charges,9.67,37.27,,7.74,percent of total billed charges,37.27% of total billed charges,9.67,37.27,,7.74,percent of total billed charges,37.27% 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,10.38,40,,8.3,percent of total billed charges,40% of total billed charges,9.67,20.76,
POTASSIUM GLUC 595MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
RAZADYNE ER 8MG CAP,6400014,CDM,250,RC,,,Outpatient,,,43.65,34.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.92,80,,27.94,percent of total billed charges,80% of total billed charges,16.27,37.27,,13.02,percent of total billed charges,37.27% of total billed charges,16.27,37.27,,13.02,percent of total billed charges,37.27% of total billed charges,16.27,37.27,,13.02,percent of total billed charges,37.27% 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,17.46,40,,13.97,percent of total billed charges,40% of total billed charges,16.27,34.92,
REQUIP 1MG,6400014,CDM,250,RC,,,Outpatient,,,10.5,8.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.4,80,,6.72,percent of total billed charges,80% of total billed charges,3.91,37.27,,3.13,percent of total billed charges,37.27% of total billed charges,3.91,37.27,,3.13,percent of total billed charges,37.27% of total billed charges,3.91,37.27,,3.13,percent of total billed charges,37.27% 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,4.2,40,,3.36,percent of total billed charges,40% of total billed charges,3.91,8.4,
DURAGESIC 12.5MG PTC,6400014,CDM,250,RC,,,Outpatient,,,69.2,55.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.36,80,,44.29,percent of total billed charges,80% of total billed charges,25.79,37.27,,20.63,percent of total billed charges,37.27% of total billed charges,25.79,37.27,,20.63,percent of total billed charges,37.27% of total billed charges,25.79,37.27,,20.63,percent of total billed charges,37.27% 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,27.68,40,,22.14,percent of total billed charges,40% of total billed charges,25.79,55.36,
ZARONTIN SYR 250/5ML,6400014,CDM,250,RC,,,Outpatient,,,100.75,80.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.6,80,,64.48,percent of total billed charges,80% of total billed charges,37.55,37.27,,30.04,percent of total billed charges,37.27% of total billed charges,37.55,37.27,,30.04,percent of total billed charges,37.27% of total billed charges,37.55,37.27,,30.04,percent of total billed charges,37.27% 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,40.3,40,,32.24,percent of total billed charges,40% of total billed charges,37.55,80.6,
WINE (PER OZ),6400014,CDM,250,RC,,,Outpatient,,,46.9,37.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.52,80,,30.02,percent of total billed charges,80% of total billed charges,17.48,37.27,,13.98,percent of total billed charges,37.27% of total billed charges,17.48,37.27,,13.98,percent of total billed charges,37.27% of total billed charges,17.48,37.27,,13.98,percent of total billed charges,37.27% 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,18.76,40,,15.01,percent of total billed charges,40% of total billed charges,17.48,37.52,
PRED FORTE 1ML,6400014,CDM,250,RC,,,Outpatient,,,86.15,68.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.92,80,,55.14,percent of total billed charges,80% of total billed charges,32.11,37.27,,25.69,percent of total billed charges,37.27% of total billed charges,32.11,37.27,,25.69,percent of total billed charges,37.27% of total billed charges,32.11,37.27,,25.69,percent of total billed charges,37.27% 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,34.46,40,,27.57,percent of total billed charges,40% of total billed charges,32.11,68.92,
DEXAM ELIX 5MG (5ML),6400014,CDM,250,RC,,,Outpatient,,,11.1,8.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.88,80,,7.1,percent of total billed charges,80% of total billed charges,4.14,37.27,,3.31,percent of total billed charges,37.27% of total billed charges,4.14,37.27,,3.31,percent of total billed charges,37.27% of total billed charges,4.14,37.27,,3.31,percent of total billed charges,37.27% 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,4.44,40,,3.55,percent of total billed charges,40% of total billed charges,4.14,8.88,
ZOLADEX IJ PER 3.6MG,6065130,CDM,636,RC,J9202,HCPCS,Outpatient,,,1381.23,1104.98,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1104.98,80,,883.98,percent of total billed charges,80% of total billed charges,514.78,37.27,,411.82,percent of total billed charges,37.27% of total billed charges,514.78,37.27,,411.82,percent of total billed charges,37.27% of total billed charges,514.78,37.27,,411.82,percent of total billed charges,37.27% of total billed charges,674.77,100,,,fee schedule,100% of APC rate,674.77,100,,,fee schedule,100% of APC rate,674.77,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,674.77,100,,,fee schedule,100% of APC rate,674.77,100,,,fee schedule,100% of APC rate,674.77,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,552.49,40,,441.99,percent of total billed charges,40% of total billed charges,514.78,1104.98,
CYPROHEP SYRUP 30ML,6400014,CDM,250,RC,,,Outpatient,,,13.9,11.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.12,80,,8.9,percent of total billed charges,80% of total billed charges,5.18,37.27,,4.14,percent of total billed charges,37.27% of total billed charges,5.18,37.27,,4.14,percent of total billed charges,37.27% of total billed charges,5.18,37.27,,4.14,percent of total billed charges,37.27% 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,5.56,40,,4.45,percent of total billed charges,40% of total billed charges,5.18,11.12,
GYRUS FORCEPS,5801832,CDM,272,RC,,,Outpatient,,,651,520.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520.8,80,,416.64,percent of total billed charges,80% of total billed charges,242.63,37.27,,194.1,percent of total billed charges,37.27% of total billed charges,242.63,37.27,,194.1,percent of total billed charges,37.27% of total billed charges,242.63,37.27,,194.1,percent of total billed charges,37.27% 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,260.4,40,,208.32,percent of total billed charges,40% of total billed charges,242.63,520.8,
BOOST VAN 8 OZ,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
DEPAKOTE ER 250MG,6400014,CDM,250,RC,,,Outpatient,,,8.3,6.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.64,80,,5.31,percent of total billed charges,80% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% 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,3.32,40,,2.66,percent of total billed charges,40% of total billed charges,3.09,6.64,
NAPROXEN EC 500MG,6400014,CDM,250,RC,,,Outpatient,,,6.6,5.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.28,80,,4.22,percent of total billed charges,80% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% 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,2.64,40,,2.11,percent of total billed charges,40% of total billed charges,2.46,5.28,
VITRASE INJ 200UN,6400014,CDM,250,RC,,,Outpatient,,,272.5,218.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,218,80,,174.4,percent of total billed charges,80% of total billed charges,101.56,37.27,,81.25,percent of total billed charges,37.27% of total billed charges,101.56,37.27,,81.25,percent of total billed charges,37.27% of total billed charges,101.56,37.27,,81.25,percent of total billed charges,37.27% 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,109,40,,87.2,percent of total billed charges,40% of total billed charges,101.56,218,
RAZADYNE 4MG TAB,6400014,CDM,250,RC,,,Outpatient,,,21.8,17.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.44,80,,13.95,percent of total billed charges,80% of total billed charges,8.12,37.27,,6.5,percent of total billed charges,37.27% of total billed charges,8.12,37.27,,6.5,percent of total billed charges,37.27% of total billed charges,8.12,37.27,,6.5,percent of total billed charges,37.27% 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,8.72,40,,6.98,percent of total billed charges,40% of total billed charges,8.12,17.44,
RAZADYNE 12MG TAB,6400014,CDM,250,RC,,,Outpatient,,,21.8,17.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.44,80,,13.95,percent of total billed charges,80% of total billed charges,8.12,37.27,,6.5,percent of total billed charges,37.27% of total billed charges,8.12,37.27,,6.5,percent of total billed charges,37.27% of total billed charges,8.12,37.27,,6.5,percent of total billed charges,37.27% 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,8.72,40,,6.98,percent of total billed charges,40% of total billed charges,8.12,17.44,
CILOXIN OPTH OINT,6400014,CDM,250,RC,,,Outpatient,,,211.65,169.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,169.32,80,,135.46,percent of total billed charges,80% of total billed charges,78.88,37.27,,63.1,percent of total billed charges,37.27% of total billed charges,78.88,37.27,,63.1,percent of total billed charges,37.27% of total billed charges,78.88,37.27,,63.1,percent of total billed charges,37.27% 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,84.66,40,,67.73,percent of total billed charges,40% of total billed charges,78.88,169.32,
PROTONIX 20MG,6400014,CDM,250,RC,,,Outpatient,,,18.4,14.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.72,80,,11.78,percent of total billed charges,80% of total billed charges,6.86,37.27,,5.49,percent of total billed charges,37.27% of total billed charges,6.86,37.27,,5.49,percent of total billed charges,37.27% of total billed charges,6.86,37.27,,5.49,percent of total billed charges,37.27% 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,7.36,40,,5.89,percent of total billed charges,40% of total billed charges,6.86,14.72,
FORADIL AEROLIZER,6400014,CDM,250,RC,,,Outpatient,,,188,150.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,70.07,37.27,,56.06,percent of total billed charges,37.27% of total billed charges,70.07,37.27,,56.06,percent of total billed charges,37.27% of total billed charges,70.07,37.27,,56.06,percent of total billed charges,37.27% 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,75.2,40,,60.16,percent of total billed charges,40% of total billed charges,70.07,150.4,
BACITRACIN INJ,6400014,CDM,250,RC,,,Outpatient,,,82.34,65.87,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.87,80,,52.7,percent of total billed charges,80% of total billed charges,30.69,37.27,,24.55,percent of total billed charges,37.27% of total billed charges,30.69,37.27,,24.55,percent of total billed charges,37.27% of total billed charges,30.69,37.27,,24.55,percent of total billed charges,37.27% 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,32.94,40,,26.35,percent of total billed charges,40% of total billed charges,30.69,65.87,
PYRIDOSTIGMINE 60MG,6400014,CDM,250,RC,,,Outpatient,,,4.35,3.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.48,80,,2.78,percent of total billed charges,80% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% 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,1.74,40,,1.39,percent of total billed charges,40% of total billed charges,1.62,3.48,
CT THOR SPINE WO,6010052,CDM,350,RC,72128,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,109.63,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,90.64,1316,
LEVAQUIN 750MG TAB,6400014,CDM,250,RC,,,Outpatient,,,263.9,211.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,211.12,80,,168.9,percent of total billed charges,80% of total billed charges,98.36,37.27,,78.69,percent of total billed charges,37.27% of total billed charges,98.36,37.27,,78.69,percent of total billed charges,37.27% of total billed charges,98.36,37.27,,78.69,percent of total billed charges,37.27% 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,105.56,40,,84.45,percent of total billed charges,40% of total billed charges,98.36,211.12,
SLOW-FE TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
POLYTUSSIN DM OZ,6400014,CDM,250,RC,,,Outpatient,,,8.9,7.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.12,80,,5.7,percent of total billed charges,80% of total billed charges,3.32,37.27,,2.66,percent of total billed charges,37.27% of total billed charges,3.32,37.27,,2.66,percent of total billed charges,37.27% of total billed charges,3.32,37.27,,2.66,percent of total billed charges,37.27% 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,3.56,40,,2.85,percent of total billed charges,40% of total billed charges,3.32,7.12,
KIDNEY STONE PANEL,7012032,CDM,300,RC,,,Outpatient,,,1308,1046.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1046.4,80,,837.12,percent of total billed charges,80% of total billed charges,487.49,37.27,,389.99,percent of total billed charges,37.27% of total billed charges,487.49,37.27,,389.99,percent of total billed charges,37.27% of total billed charges,487.49,37.27,,389.99,percent of total billed charges,37.27% 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,523.2,40,,418.56,percent of total billed charges,40% of total billed charges,487.49,1046.4,
PROVENTIL HFA INH,6400014,CDM,250,RC,,,Outpatient,,,163.8,131.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.04,80,,104.83,percent of total billed charges,80% of total billed charges,61.05,37.27,,48.84,percent of total billed charges,37.27% of total billed charges,61.05,37.27,,48.84,percent of total billed charges,37.27% of total billed charges,61.05,37.27,,48.84,percent of total billed charges,37.27% 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,65.52,40,,52.42,percent of total billed charges,40% of total billed charges,61.05,131.04,
PROVENTIL INH 17GM,6400014,CDM,250,RC,,,Outpatient,,,129.15,103.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.32,80,,82.66,percent of total billed charges,80% of total billed charges,48.13,37.27,,38.5,percent of total billed charges,37.27% of total billed charges,48.13,37.27,,38.5,percent of total billed charges,37.27% of total billed charges,48.13,37.27,,38.5,percent of total billed charges,37.27% 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,51.66,40,,41.33,percent of total billed charges,40% of total billed charges,48.13,103.32,
ETHIODOL INJ,6400014,CDM,250,RC,,,Outpatient,,,420.6,336.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,336.48,80,,269.18,percent of total billed charges,80% of total billed charges,156.76,37.27,,125.41,percent of total billed charges,37.27% of total billed charges,156.76,37.27,,125.41,percent of total billed charges,37.27% of total billed charges,156.76,37.27,,125.41,percent of total billed charges,37.27% 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,168.24,40,,134.59,percent of total billed charges,40% of total billed charges,156.76,336.48,
ROZEREM 8MG TAB,6400014,CDM,250,RC,,,Outpatient,,,53.05,42.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.44,80,,33.95,percent of total billed charges,80% of total billed charges,19.77,37.27,,15.82,percent of total billed charges,37.27% of total billed charges,19.77,37.27,,15.82,percent of total billed charges,37.27% of total billed charges,19.77,37.27,,15.82,percent of total billed charges,37.27% 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,21.22,40,,16.98,percent of total billed charges,40% of total billed charges,19.77,42.44,
BROMOCRIPTINE 2.5 TB,6400014,CDM,250,RC,,,Outpatient,,,14.1,11.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.28,80,,9.02,percent of total billed charges,80% of total billed charges,5.26,37.27,,4.21,percent of total billed charges,37.27% of total billed charges,5.26,37.27,,4.21,percent of total billed charges,37.27% of total billed charges,5.26,37.27,,4.21,percent of total billed charges,37.27% 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,5.64,40,,4.51,percent of total billed charges,40% of total billed charges,5.26,11.28,
K-PHOS NEUTRAL TAB,6400014,CDM,250,RC,,,Outpatient,,,3,2.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.4,80,,1.92,percent of total billed charges,80% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% of total billed charges,1.12,37.27,,0.9,percent of total billed charges,37.27% 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,1.2,40,,0.96,percent of total billed charges,40% of total billed charges,1.12,2.4,
AMOXIL 400MG SUSP,6400014,CDM,250,RC,,,Outpatient,,,23.5,18.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.8,80,,15.04,percent of total billed charges,80% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% 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,9.4,40,,7.52,percent of total billed charges,40% of total billed charges,8.76,18.8,
LESCOL XL 80MG,6400014,CDM,250,RC,,,Outpatient,,,55.85,44.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.68,80,,35.74,percent of total billed charges,80% of total billed charges,20.82,37.27,,16.66,percent of total billed charges,37.27% of total billed charges,20.82,37.27,,16.66,percent of total billed charges,37.27% of total billed charges,20.82,37.27,,16.66,percent of total billed charges,37.27% 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,22.34,40,,17.87,percent of total billed charges,40% of total billed charges,20.82,44.68,
PAROXETINE 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,8.6,6.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.88,80,,5.5,percent of total billed charges,80% of total billed charges,3.21,37.27,,2.57,percent of total billed charges,37.27% of total billed charges,3.21,37.27,,2.57,percent of total billed charges,37.27% of total billed charges,3.21,37.27,,2.57,percent of total billed charges,37.27% 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,3.44,40,,2.75,percent of total billed charges,40% of total billed charges,3.21,6.88,
ATACAND 4MG TAB,6400014,CDM,250,RC,,,Outpatient,,,14.5,11.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.6,80,,9.28,percent of total billed charges,80% of total billed charges,5.4,37.27,,4.32,percent of total billed charges,37.27% of total billed charges,5.4,37.27,,4.32,percent of total billed charges,37.27% of total billed charges,5.4,37.27,,4.32,percent of total billed charges,37.27% 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,5.8,40,,4.64,percent of total billed charges,40% of total billed charges,5.4,11.6,
MECLOFENAMATE 100MG,6400014,CDM,250,RC,,,Outpatient,,,21.95,17.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.56,80,,14.05,percent of total billed charges,80% of total billed charges,8.18,37.27,,6.54,percent of total billed charges,37.27% of total billed charges,8.18,37.27,,6.54,percent of total billed charges,37.27% of total billed charges,8.18,37.27,,6.54,percent of total billed charges,37.27% 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,8.78,40,,7.02,percent of total billed charges,40% of total billed charges,8.18,17.56,
WELCHOL 625MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.05,2.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.44,80,,1.95,percent of total billed charges,80% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% 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,1.22,40,,0.98,percent of total billed charges,40% of total billed charges,1.14,2.44,
PAN MIST JR TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
FLUCONAZOLE 200MG IV,6065130,CDM,636,RC,J1450,HCPCS,Outpatient,,,381.5,305.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,305.2,80,,244.16,percent of total billed charges,80% of total billed charges,142.19,37.27,,113.75,percent of total billed charges,37.27% of total billed charges,142.19,37.27,,113.75,percent of total billed charges,37.27% of total billed charges,142.19,37.27,,113.75,percent of total billed charges,37.27% 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,152.6,40,,122.08,percent of total billed charges,40% of total billed charges,142.19,305.2,
FLUCONAZOLE 400MG IJ,6065130,CDM,636,RC,J1450,HCPCS,Outpatient,,,227.78,182.22,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,182.22,80,,145.78,percent of total billed charges,80% of total billed charges,84.89,37.27,,67.91,percent of total billed charges,37.27% of total billed charges,84.89,37.27,,67.91,percent of total billed charges,37.27% of total billed charges,84.89,37.27,,67.91,percent of total billed charges,37.27% 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,91.11,40,,72.89,percent of total billed charges,40% of total billed charges,84.89,182.22,
HYDROCORT 2.5% OINT,6400014,CDM,250,RC,,,Outpatient,,,37.5,30.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,80,,24,percent of total billed charges,80% of total billed charges,13.98,37.27,,11.18,percent of total billed charges,37.27% of total billed charges,13.98,37.27,,11.18,percent of total billed charges,37.27% of total billed charges,13.98,37.27,,11.18,percent of total billed charges,37.27% 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,15,40,,12,percent of total billed charges,40% of total billed charges,13.98,30,
MARINOL 2.5MG CAP,6400014,CDM,250,RC,,,Outpatient,,,39.7,31.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.76,80,,25.41,percent of total billed charges,80% of total billed charges,14.8,37.27,,11.84,percent of total billed charges,37.27% of total billed charges,14.8,37.27,,11.84,percent of total billed charges,37.27% of total billed charges,14.8,37.27,,11.84,percent of total billed charges,37.27% 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,15.88,40,,12.7,percent of total billed charges,40% of total billed charges,14.8,31.76,
HAB CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,7.25,5.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.8,80,,4.64,percent of total billed charges,80% of total billed charges,2.7,37.27,,2.16,percent of total billed charges,37.27% of total billed charges,2.7,37.27,,2.16,percent of total billed charges,37.27% of total billed charges,2.7,37.27,,2.16,percent of total billed charges,37.27% 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,2.9,40,,2.32,percent of total billed charges,40% of total billed charges,2.7,5.8,
XENICAL 120MG CAP,6400014,CDM,250,RC,,,Outpatient,,,19.55,15.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.64,80,,12.51,percent of total billed charges,80% of total billed charges,7.29,37.27,,5.83,percent of total billed charges,37.27% of total billed charges,7.29,37.27,,5.83,percent of total billed charges,37.27% of total billed charges,7.29,37.27,,5.83,percent of total billed charges,37.27% 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,7.82,40,,6.26,percent of total billed charges,40% of total billed charges,7.29,15.64,
ACTIVELLA 1/0.5MG PK,6400014,CDM,250,RC,,,Outpatient,,,585.55,468.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,468.44,80,,374.75,percent of total billed charges,80% of total billed charges,218.23,37.27,,174.58,percent of total billed charges,37.27% of total billed charges,218.23,37.27,,174.58,percent of total billed charges,37.27% of total billed charges,218.23,37.27,,174.58,percent of total billed charges,37.27% 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,234.22,40,,187.38,percent of total billed charges,40% of total billed charges,218.23,468.44,
EFFERDENT TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
APLIGRAF PER SQCM,6065130,CDM,636,RC,Q4101,HCPCS,Outpatient,,,75.28,60.22,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.22,80,,48.18,percent of total billed charges,80% of total billed charges,28.06,37.27,,22.45,percent of total billed charges,37.27% of total billed charges,28.06,37.27,,22.45,percent of total billed charges,37.27% of total billed charges,28.06,37.27,,22.45,percent of total billed charges,37.27% 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,30.11,40,,24.09,percent of total billed charges,40% of total billed charges,28.06,60.22,
CIPRODEX OPTH,5880901,CDM,637,RC,,,Outpatient,,,869.8,695.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,695.84,80,,556.67,percent of total billed charges,80% of total billed charges,324.17,37.27,,259.34,percent of total billed charges,37.27% of total billed charges,324.17,37.27,,259.34,percent of total billed charges,37.27% of total billed charges,324.17,37.27,,259.34,percent of total billed charges,37.27% 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,347.92,40,,278.34,percent of total billed charges,40% of total billed charges,324.17,695.84,
ZADITOR 0.025% OPTH,6400014,CDM,250,RC,,,Outpatient,,,224.15,179.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.32,80,,143.46,percent of total billed charges,80% of total billed charges,83.54,37.27,,66.83,percent of total billed charges,37.27% of total billed charges,83.54,37.27,,66.83,percent of total billed charges,37.27% of total billed charges,83.54,37.27,,66.83,percent of total billed charges,37.27% 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,89.66,40,,71.73,percent of total billed charges,40% of total billed charges,83.54,179.32,
ASMANEX INHALER,6400014,CDM,250,RC,,,Outpatient,,,381.8,305.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,305.44,80,,244.35,percent of total billed charges,80% of total billed charges,142.3,37.27,,113.84,percent of total billed charges,37.27% of total billed charges,142.3,37.27,,113.84,percent of total billed charges,37.27% of total billed charges,142.3,37.27,,113.84,percent of total billed charges,37.27% 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,152.72,40,,122.18,percent of total billed charges,40% of total billed charges,142.3,305.44,
ASMANEX INH (14),6400014,CDM,250,RC,,,Outpatient,,,250.75,200.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.6,80,,160.48,percent of total billed charges,80% of total billed charges,93.45,37.27,,74.76,percent of total billed charges,37.27% of total billed charges,93.45,37.27,,74.76,percent of total billed charges,37.27% of total billed charges,93.45,37.27,,74.76,percent of total billed charges,37.27% 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,100.3,40,,80.24,percent of total billed charges,40% of total billed charges,93.45,200.6,
ULTRAM ER 200MG TAB,6400014,CDM,250,RC,,,Outpatient,,,27.5,22.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22,80,,17.6,percent of total billed charges,80% of total billed charges,10.25,37.27,,8.2,percent of total billed charges,37.27% of total billed charges,10.25,37.27,,8.2,percent of total billed charges,37.27% of total billed charges,10.25,37.27,,8.2,percent of total billed charges,37.27% 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,11,40,,8.8,percent of total billed charges,40% of total billed charges,10.25,22,
ORAJEL BABY GEL,6400014,CDM,250,RC,,,Outpatient,,,14.85,11.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.88,80,,9.5,percent of total billed charges,80% of total billed charges,5.53,37.27,,4.42,percent of total billed charges,37.27% of total billed charges,5.53,37.27,,4.42,percent of total billed charges,37.27% of total billed charges,5.53,37.27,,4.42,percent of total billed charges,37.27% 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,5.94,40,,4.75,percent of total billed charges,40% of total billed charges,5.53,11.88,
CLARINEX SYRUP (OZ),6400014,CDM,250,RC,,,Outpatient,,,82.5,66.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,80,,52.8,percent of total billed charges,80% of total billed charges,30.75,37.27,,24.6,percent of total billed charges,37.27% of total billed charges,30.75,37.27,,24.6,percent of total billed charges,37.27% of total billed charges,30.75,37.27,,24.6,percent of total billed charges,37.27% 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,33,40,,26.4,percent of total billed charges,40% of total billed charges,30.75,66,
METANX TAB,6400014,CDM,250,RC,,,Outpatient,,,3.2,2.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.56,80,,2.05,percent of total billed charges,80% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% of total billed charges,1.19,37.27,,0.95,percent of total billed charges,37.27% 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,1.28,40,,1.02,percent of total billed charges,40% of total billed charges,1.19,2.56,
CLARINEX REDITAB 5MG,6400014,CDM,250,RC,,,Outpatient,,,20.6,16.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.48,80,,13.18,percent of total billed charges,80% of total billed charges,7.68,37.27,,6.14,percent of total billed charges,37.27% of total billed charges,7.68,37.27,,6.14,percent of total billed charges,37.27% of total billed charges,7.68,37.27,,6.14,percent of total billed charges,37.27% 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,8.24,40,,6.59,percent of total billed charges,40% of total billed charges,7.68,16.48,
CANASA SUPP 1000MG,6400014,CDM,250,RC,,,Outpatient,,,66.3,53.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.04,80,,42.43,percent of total billed charges,80% of total billed charges,24.71,37.27,,19.77,percent of total billed charges,37.27% of total billed charges,24.71,37.27,,19.77,percent of total billed charges,37.27% of total billed charges,24.71,37.27,,19.77,percent of total billed charges,37.27% 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,26.52,40,,21.22,percent of total billed charges,40% of total billed charges,24.71,53.04,
LO/OVRAL 28 PER PK,6400014,CDM,250,RC,,,Outpatient,,,243.2,194.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,194.56,80,,155.65,percent of total billed charges,80% of total billed charges,90.64,37.27,,72.51,percent of total billed charges,37.27% of total billed charges,90.64,37.27,,72.51,percent of total billed charges,37.27% of total billed charges,90.64,37.27,,72.51,percent of total billed charges,37.27% 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,97.28,40,,77.82,percent of total billed charges,40% of total billed charges,90.64,194.56,
THIOTHIXENE 10MG CAP,6400014,CDM,250,RC,,,Outpatient,,,6.1,4.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.88,80,,3.9,percent of total billed charges,80% of total billed charges,2.27,37.27,,1.82,percent of total billed charges,37.27% of total billed charges,2.27,37.27,,1.82,percent of total billed charges,37.27% of total billed charges,2.27,37.27,,1.82,percent of total billed charges,37.27% 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,2.44,40,,1.95,percent of total billed charges,40% of total billed charges,2.27,4.88,
NOVOLOG MIX 70/30,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,129.65,103.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.72,80,,82.98,percent of total billed charges,80% of total billed charges,48.32,37.27,,38.66,percent of total billed charges,37.27% of total billed charges,48.32,37.27,,38.66,percent of total billed charges,37.27% of total billed charges,48.32,37.27,,38.66,percent of total billed charges,37.27% 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,51.86,40,,41.49,percent of total billed charges,40% of total billed charges,48.32,103.72,
MIVACRON 5ML VIAL,6400014,CDM,250,RC,,,Outpatient,,,105.65,84.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.52,80,,67.62,percent of total billed charges,80% of total billed charges,39.38,37.27,,31.5,percent of total billed charges,37.27% of total billed charges,39.38,37.27,,31.5,percent of total billed charges,37.27% of total billed charges,39.38,37.27,,31.5,percent of total billed charges,37.27% 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,42.26,40,,33.81,percent of total billed charges,40% of total billed charges,39.38,84.52,
POLY-VI-SOL DROPS,6400014,CDM,250,RC,,,Outpatient,,,29.2,23.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,80,,18.69,percent of total billed charges,80% of total billed charges,10.88,37.27,,8.7,percent of total billed charges,37.27% of total billed charges,10.88,37.27,,8.7,percent of total billed charges,37.27% of total billed charges,10.88,37.27,,8.7,percent of total billed charges,37.27% 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,11.68,40,,9.34,percent of total billed charges,40% of total billed charges,10.88,23.36,
CARBAMAZINE SUPP 400,6400014,CDM,250,RC,,,Outpatient,,,12.5,10.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,80,,8,percent of total billed charges,80% of total billed charges,4.66,37.27,,3.73,percent of total billed charges,37.27% of total billed charges,4.66,37.27,,3.73,percent of total billed charges,37.27% of total billed charges,4.66,37.27,,3.73,percent of total billed charges,37.27% 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,5,40,,4,percent of total billed charges,40% of total billed charges,4.66,10,
LACTOSE TOL PANEL,7012032,CDM,300,RC,,,Outpatient,,,115,92.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% 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,46,40,,36.8,percent of total billed charges,40% of total billed charges,42.86,92,
GUIATUSS CF SYR (OZ),6400014,CDM,250,RC,,,Outpatient,,,8.9,7.12,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.12,80,,5.7,percent of total billed charges,80% of total billed charges,3.32,37.27,,2.66,percent of total billed charges,37.27% of total billed charges,3.32,37.27,,2.66,percent of total billed charges,37.27% of total billed charges,3.32,37.27,,2.66,percent of total billed charges,37.27% 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,3.56,40,,2.85,percent of total billed charges,40% of total billed charges,3.32,7.12,
LAMICTAL 25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,94.95,75.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.96,80,,60.77,percent of total billed charges,80% of total billed charges,35.39,37.27,,28.31,percent of total billed charges,37.27% of total billed charges,35.39,37.27,,28.31,percent of total billed charges,37.27% of total billed charges,35.39,37.27,,28.31,percent of total billed charges,37.27% 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,37.98,40,,30.38,percent of total billed charges,40% of total billed charges,35.39,75.96,
SINGULAIR 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,21.4,17.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.12,80,,13.7,percent of total billed charges,80% of total billed charges,7.98,37.27,,6.38,percent of total billed charges,37.27% of total billed charges,7.98,37.27,,6.38,percent of total billed charges,37.27% of total billed charges,7.98,37.27,,6.38,percent of total billed charges,37.27% 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,8.56,40,,6.85,percent of total billed charges,40% of total billed charges,7.98,17.12,
CO-ENZYME Q 30MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
LOTEMAX OPTH SUSP,6400014,CDM,250,RC,,,Outpatient,,,162.25,129.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.8,80,,103.84,percent of total billed charges,80% of total billed charges,60.47,37.27,,48.38,percent of total billed charges,37.27% of total billed charges,60.47,37.27,,48.38,percent of total billed charges,37.27% of total billed charges,60.47,37.27,,48.38,percent of total billed charges,37.27% 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,64.9,40,,51.92,percent of total billed charges,40% of total billed charges,60.47,129.8,
METHANAMINE 1000MG,6400014,CDM,250,RC,,,Outpatient,,,8.05,6.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.44,80,,5.15,percent of total billed charges,80% of total billed charges,3,37.27,,2.4,percent of total billed charges,37.27% of total billed charges,3,37.27,,2.4,percent of total billed charges,37.27% of total billed charges,3,37.27,,2.4,percent of total billed charges,37.27% 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,3.22,40,,2.58,percent of total billed charges,40% of total billed charges,3,6.44,
TARKA 2/180,6400014,CDM,250,RC,,,Outpatient,,,18.2,14.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.56,80,,11.65,percent of total billed charges,80% of total billed charges,6.78,37.27,,5.42,percent of total billed charges,37.27% of total billed charges,6.78,37.27,,5.42,percent of total billed charges,37.27% of total billed charges,6.78,37.27,,5.42,percent of total billed charges,37.27% 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,7.28,40,,5.82,percent of total billed charges,40% of total billed charges,6.78,14.56,
FOSINOPRIL 40MG,6400014,CDM,250,RC,,,Outpatient,,,1,0.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,80,,0.64,percent of total billed charges,80% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% 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,0.4,40,,0.32,percent of total billed charges,40% of total billed charges,0.37,0.8,
LUPRON DEP PER3.75MG,6065130,CDM,636,RC,J1950,HCPCS,Outpatient,,,1200.52,960.42,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960.42,80,,768.34,percent of total billed charges,80% of total billed charges,447.43,37.27,,357.94,percent of total billed charges,37.27% of total billed charges,447.43,37.27,,357.94,percent of total billed charges,37.27% of total billed charges,447.43,37.27,,357.94,percent of total billed charges,37.27% of total billed charges,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,480.21,40,,384.17,percent of total billed charges,40% of total billed charges,447.43,1617.65,
ROBITUSSIN S/F 30ML,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
RELPAX 40MG TAB,6400014,CDM,250,RC,,,Outpatient,,,118.45,94.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.76,80,,75.81,percent of total billed charges,80% of total billed charges,44.15,37.27,,35.32,percent of total billed charges,37.27% of total billed charges,44.15,37.27,,35.32,percent of total billed charges,37.27% of total billed charges,44.15,37.27,,35.32,percent of total billed charges,37.27% 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,47.38,40,,37.9,percent of total billed charges,40% of total billed charges,44.15,94.76,
BYETTA 5 MCG PEN,5880901,CDM,637,RC,,,Outpatient,,,2980.6,2384.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2384.48,80,,1907.58,percent of total billed charges,80% of total billed charges,1110.87,37.27,,888.7,percent of total billed charges,37.27% of total billed charges,1110.87,37.27,,888.7,percent of total billed charges,37.27% of total billed charges,1110.87,37.27,,888.7,percent of total billed charges,37.27% 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,1192.24,40,,953.79,percent of total billed charges,40% of total billed charges,1110.87,2384.48,
BETA DPR CR AUG 15G,6400014,CDM,250,RC,,,Outpatient,,,125.15,100.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.12,80,,80.1,percent of total billed charges,80% of total billed charges,46.64,37.27,,37.31,percent of total billed charges,37.27% of total billed charges,46.64,37.27,,37.31,percent of total billed charges,37.27% of total billed charges,46.64,37.27,,37.31,percent of total billed charges,37.27% 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,50.06,40,,40.05,percent of total billed charges,40% of total billed charges,46.64,100.12,
FACTOR VIII IJ PER U,6065130,CDM,636,RC,J7190,HCPCS,Outpatient,,,3.45,2.76,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.76,80,,2.21,percent of total billed charges,80% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.17,100,,,fee schedule,100% of APC rate,1.17,100,,,fee schedule,100% of APC rate,1.17,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1.17,100,,,fee schedule,100% of APC rate,1.17,100,,,fee schedule,100% of APC rate,1.17,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.38,40,,1.1,percent of total billed charges,40% of total billed charges,1.17,2.76,
FEMHRT 1/5,6400014,CDM,250,RC,,,Outpatient,,,250.2,200.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.16,80,,160.13,percent of total billed charges,80% of total billed charges,93.25,37.27,,74.6,percent of total billed charges,37.27% of total billed charges,93.25,37.27,,74.6,percent of total billed charges,37.27% of total billed charges,93.25,37.27,,74.6,percent of total billed charges,37.27% 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,100.08,40,,80.06,percent of total billed charges,40% of total billed charges,93.25,200.16,
HYSKON DEXTRAN 100ML,6400014,CDM,250,RC,,,Outpatient,,,99.15,79.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.32,80,,63.46,percent of total billed charges,80% of total billed charges,36.95,37.27,,29.56,percent of total billed charges,37.27% of total billed charges,36.95,37.27,,29.56,percent of total billed charges,37.27% of total billed charges,36.95,37.27,,29.56,percent of total billed charges,37.27% 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,39.66,40,,31.73,percent of total billed charges,40% of total billed charges,36.95,79.32,
DESOXIMETASONE OINT,6400014,CDM,250,RC,,,Outpatient,,,85.34,68.27,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.27,80,,54.62,percent of total billed charges,80% of total billed charges,31.81,37.27,,25.45,percent of total billed charges,37.27% of total billed charges,31.81,37.27,,25.45,percent of total billed charges,37.27% of total billed charges,31.81,37.27,,25.45,percent of total billed charges,37.27% 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,34.14,40,,27.31,percent of total billed charges,40% of total billed charges,31.81,68.27,
FASLODEX 25MG/2.5ML,6065130,CDM,636,RC,J9395,HCPCS,Outpatient,,,385.32,308.26,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308.26,80,,246.61,percent of total billed charges,80% of total billed charges,143.61,37.27,,114.89,percent of total billed charges,37.27% of total billed charges,143.61,37.27,,114.89,percent of total billed charges,37.27% of total billed charges,143.61,37.27,,114.89,percent of total billed charges,37.27% of total billed charges,7.51,100,,,fee schedule,100% of APC rate,7.51,100,,,fee schedule,100% of APC rate,7.51,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,7.51,100,,,fee schedule,100% of APC rate,7.51,100,,,fee schedule,100% of APC rate,7.51,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.13,40,,123.3,percent of total billed charges,40% of total billed charges,7.51,308.26,
DYTAN SUSPENSION,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
SOD.BICARB 4.2% 5ML,6400014,CDM,250,RC,,,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
BLISTEX OINTMENT,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
HALDOL DEC 100MG VL,6065130,CDM,636,RC,J1631,HCPCS,Outpatient,,,358.85,287.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,287.08,80,,229.66,percent of total billed charges,80% of total billed charges,133.74,37.27,,106.99,percent of total billed charges,37.27% of total billed charges,133.74,37.27,,106.99,percent of total billed charges,37.27% of total billed charges,133.74,37.27,,106.99,percent of total billed charges,37.27% 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,143.54,40,,114.83,percent of total billed charges,40% of total billed charges,133.74,287.08,
ENABLEX 15MG TAB,6400014,CDM,250,RC,,,Outpatient,,,19,15.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% 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,7.6,40,,6.08,percent of total billed charges,40% of total billed charges,7.08,15.2,
BIAXIN 125/5ML 50ML,5880901,CDM,637,RC,,,Outpatient,,,102.4,81.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.92,80,,65.54,percent of total billed charges,80% of total billed charges,38.16,37.27,,30.53,percent of total billed charges,37.27% of total billed charges,38.16,37.27,,30.53,percent of total billed charges,37.27% of total billed charges,38.16,37.27,,30.53,percent of total billed charges,37.27% 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,40.96,40,,32.77,percent of total billed charges,40% of total billed charges,38.16,81.92,
NITROGLYCERIN 6.5MG,6400014,CDM,250,RC,,,Outpatient,,,3.4,2.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.72,80,,2.18,percent of total billed charges,80% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% 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,1.36,40,,1.09,percent of total billed charges,40% of total billed charges,1.27,2.72,
DIPYRIDAMOLE 25MG,6400014,CDM,250,RC,,,Outpatient,,,4.85,3.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.88,80,,3.1,percent of total billed charges,80% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% 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,1.94,40,,1.55,percent of total billed charges,40% of total billed charges,1.81,3.88,
JERGENS LOTION,6400014,CDM,250,RC,,,Outpatient,,,34.9,27.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.92,80,,22.34,percent of total billed charges,80% of total billed charges,13.01,37.27,,10.41,percent of total billed charges,37.27% of total billed charges,13.01,37.27,,10.41,percent of total billed charges,37.27% of total billed charges,13.01,37.27,,10.41,percent of total billed charges,37.27% 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,13.96,40,,11.17,percent of total billed charges,40% of total billed charges,13.01,27.92,
FORTEO INJ PER 10MCG,6065130,CDM,636,RC,J3110,HCPCS,Outpatient,,,101.04,80.83,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.83,80,,64.66,percent of total billed charges,80% of total billed charges,37.66,37.27,,30.13,percent of total billed charges,37.27% of total billed charges,37.66,37.27,,30.13,percent of total billed charges,37.27% of total billed charges,37.66,37.27,,30.13,percent of total billed charges,37.27% 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,40.42,40,,32.34,percent of total billed charges,40% of total billed charges,37.66,80.83,
METHAZOLAMIDE 25MG,6400014,CDM,250,RC,,,Outpatient,,,1.95,1.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.56,80,,1.25,percent of total billed charges,80% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% of total billed charges,0.73,37.27,,0.58,percent of total billed charges,37.27% 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,0.78,40,,0.62,percent of total billed charges,40% of total billed charges,0.73,1.56,
VITAMIN D 400 IU TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PIC TRAY 20G CATH 20,5645742,CDM,270,RC,,,Outpatient,,,135,108.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108,80,,86.4,percent of total billed charges,80% of total billed charges,50.31,37.27,,40.25,percent of total billed charges,37.27% of total billed charges,50.31,37.27,,40.25,percent of total billed charges,37.27% of total billed charges,50.31,37.27,,40.25,percent of total billed charges,37.27% 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,54,40,,43.2,percent of total billed charges,40% of total billed charges,50.31,108,
TROCAR 12MM BLUNT,5801832,CDM,272,RC,,,Outpatient,,,383,306.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,306.4,80,,245.12,percent of total billed charges,80% of total billed charges,142.74,37.27,,114.19,percent of total billed charges,37.27% of total billed charges,142.74,37.27,,114.19,percent of total billed charges,37.27% of total billed charges,142.74,37.27,,114.19,percent of total billed charges,37.27% 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,153.2,40,,122.56,percent of total billed charges,40% of total billed charges,142.74,306.4,
MESH DUAL 10X15,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,1114,891.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,891.2,80,,712.96,percent of total billed charges,80% of total billed charges,415.19,37.27,,332.15,percent of total billed charges,37.27% of total billed charges,415.19,37.27,,332.15,percent of total billed charges,37.27% of total billed charges,415.19,37.27,,332.15,percent of total billed charges,37.27% 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,445.6,40,,356.48,percent of total billed charges,40% of total billed charges,415.19,891.2,
MESH DUAL 8X12,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,940,752.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,752,80,,601.6,percent of total billed charges,80% of total billed charges,350.34,37.27,,280.27,percent of total billed charges,37.27% of total billed charges,350.34,37.27,,280.27,percent of total billed charges,37.27% of total billed charges,350.34,37.27,,280.27,percent of total billed charges,37.27% 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,376,40,,300.8,percent of total billed charges,40% of total billed charges,350.34,752,
CAST SUPPLIES,5645742,CDM,270,RC,,,Outpatient,,,241,192.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,89.82,37.27,,71.86,percent of total billed charges,37.27% of total billed charges,89.82,37.27,,71.86,percent of total billed charges,37.27% of total billed charges,89.82,37.27,,71.86,percent of total billed charges,37.27% 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,96.4,40,,77.12,percent of total billed charges,40% of total billed charges,89.82,192.8,
ALCOHOL IJ 98% 1ML,6400014,CDM,250,RC,,,Outpatient,,,42.6,34.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.08,80,,27.26,percent of total billed charges,80% of total billed charges,15.88,37.27,,12.7,percent of total billed charges,37.27% of total billed charges,15.88,37.27,,12.7,percent of total billed charges,37.27% of total billed charges,15.88,37.27,,12.7,percent of total billed charges,37.27% 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,17.04,40,,13.63,percent of total billed charges,40% of total billed charges,15.88,34.08,
GRISEOFULVIN 250MG,6400014,CDM,250,RC,,,Outpatient,,,198.35,158.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.68,80,,126.94,percent of total billed charges,80% of total billed charges,73.93,37.27,,59.14,percent of total billed charges,37.27% of total billed charges,73.93,37.27,,59.14,percent of total billed charges,37.27% of total billed charges,73.93,37.27,,59.14,percent of total billed charges,37.27% 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,79.34,40,,63.47,percent of total billed charges,40% of total billed charges,73.93,158.68,
EPOETIN (<10KU),6065130,CDM,636,RC,J0885,HCPCS,Outpatient,,,50.2,40.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.16,80,,32.13,percent of total billed charges,80% of total billed charges,18.71,37.27,,14.97,percent of total billed charges,37.27% of total billed charges,18.71,37.27,,14.97,percent of total billed charges,37.27% of total billed charges,18.71,37.27,,14.97,percent of total billed charges,37.27% of total billed charges,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,7.53,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.08,40,,16.06,percent of total billed charges,40% of total billed charges,7.53,40.16,
IPECAC SYRUP (OZ),6400014,CDM,250,RC,,,Outpatient,,,16,12.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% 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,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,5.96,12.8,
CHLORDIAZ 10MG CAP,6400014,CDM,250,RC,,,Outpatient,,,2.85,2.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,80,,1.82,percent of total billed charges,80% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% of total billed charges,1.06,37.27,,0.85,percent of total billed charges,37.27% 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,1.14,40,,0.91,percent of total billed charges,40% of total billed charges,1.06,2.28,
PEROXYL GEL,6400014,CDM,250,RC,,,Outpatient,,,155.68,124.54,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.54,80,,99.63,percent of total billed charges,80% of total billed charges,58.02,37.27,,46.42,percent of total billed charges,37.27% of total billed charges,58.02,37.27,,46.42,percent of total billed charges,37.27% of total billed charges,58.02,37.27,,46.42,percent of total billed charges,37.27% 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,62.27,40,,49.82,percent of total billed charges,40% of total billed charges,58.02,124.54,
MESH DUAL 18X24,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,2168,1734.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1734.4,80,,1387.52,percent of total billed charges,80% of total billed charges,808.01,37.27,,646.41,percent of total billed charges,37.27% of total billed charges,808.01,37.27,,646.41,percent of total billed charges,37.27% of total billed charges,808.01,37.27,,646.41,percent of total billed charges,37.27% 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,867.2,40,,693.76,percent of total billed charges,40% of total billed charges,808.01,1734.4,
WOUND VAC DRESNG MED,5645742,CDM,270,RC,,,Outpatient,,,162,129.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% 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,64.8,40,,51.84,percent of total billed charges,40% of total billed charges,60.38,129.6,
WND VAC CAN 500-1000,5645742,CDM,270,RC,,,Outpatient,,,180,144.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,80,,115.2,percent of total billed charges,80% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% 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,72,40,,57.6,percent of total billed charges,40% of total billed charges,67.09,144,
LIDO/PRILO CR 5GM,6400014,CDM,250,RC,,,Outpatient,,,26.4,21.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.12,80,,16.9,percent of total billed charges,80% of total billed charges,9.84,37.27,,7.87,percent of total billed charges,37.27% of total billed charges,9.84,37.27,,7.87,percent of total billed charges,37.27% of total billed charges,9.84,37.27,,7.87,percent of total billed charges,37.27% 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,10.56,40,,8.45,percent of total billed charges,40% of total billed charges,9.84,21.12,
HEPATASOL 8% 500ML,6400014,CDM,250,RC,,,Outpatient,,,371.25,297.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,297,80,,237.6,percent of total billed charges,80% of total billed charges,138.36,37.27,,110.69,percent of total billed charges,37.27% of total billed charges,138.36,37.27,,110.69,percent of total billed charges,37.27% of total billed charges,138.36,37.27,,110.69,percent of total billed charges,37.27% 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,148.5,40,,118.8,percent of total billed charges,40% of total billed charges,138.36,297,
MERREM 1GM(PER100MG),6065130,CDM,636,RC,J2185,HCPCS,Outpatient,,,27.46,21.97,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.97,80,,17.58,percent of total billed charges,80% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% of total billed charges,10.23,37.27,,8.18,percent of total billed charges,37.27% 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,10.98,40,,8.78,percent of total billed charges,40% of total billed charges,10.23,21.97,
WELCHOL 625MG,6400014,CDM,250,RC,,,Outpatient,,,15.2,12.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,80,,9.73,percent of total billed charges,80% of total billed charges,5.67,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.67,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.67,37.27,,4.54,percent of total billed charges,37.27% 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,6.08,40,,4.86,percent of total billed charges,40% of total billed charges,5.67,12.16,
TRICOR 48MG TAB,6400014,CDM,250,RC,,,Outpatient,,,8.9,7.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.12,80,,5.7,percent of total billed charges,80% of total billed charges,3.32,37.27,,2.66,percent of total billed charges,37.27% of total billed charges,3.32,37.27,,2.66,percent of total billed charges,37.27% of total billed charges,3.32,37.27,,2.66,percent of total billed charges,37.27% 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,3.56,40,,2.85,percent of total billed charges,40% of total billed charges,3.32,7.12,
CRESTOR 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,17.8,14.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.24,80,,11.39,percent of total billed charges,80% of total billed charges,6.63,37.27,,5.3,percent of total billed charges,37.27% of total billed charges,6.63,37.27,,5.3,percent of total billed charges,37.27% of total billed charges,6.63,37.27,,5.3,percent of total billed charges,37.27% 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,7.12,40,,5.7,percent of total billed charges,40% of total billed charges,6.63,14.24,
KETOCONAZOLE 200MG,6400014,CDM,250,RC,,,Outpatient,,,21.3,17.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.04,80,,13.63,percent of total billed charges,80% of total billed charges,7.94,37.27,,6.35,percent of total billed charges,37.27% of total billed charges,7.94,37.27,,6.35,percent of total billed charges,37.27% of total billed charges,7.94,37.27,,6.35,percent of total billed charges,37.27% 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,8.52,40,,6.82,percent of total billed charges,40% of total billed charges,7.94,17.04,
PROTAMINE 10MG/ML,6065130,CDM,636,RC,J2720,HCPCS,Outpatient,,,216.5,173.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.2,80,,138.56,percent of total billed charges,80% of total billed charges,80.69,37.27,,64.55,percent of total billed charges,37.27% of total billed charges,80.69,37.27,,64.55,percent of total billed charges,37.27% of total billed charges,80.69,37.27,,64.55,percent of total billed charges,37.27% 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,86.6,40,,69.28,percent of total billed charges,40% of total billed charges,80.69,173.2,
HYDROCOD/APAP 10/500,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
MULTIPLE SCLERO PROF,7012032,CDM,300,RC,,,Outpatient,,,393,314.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314.4,80,,251.52,percent of total billed charges,80% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% of total billed charges,146.47,37.27,,117.18,percent of total billed charges,37.27% 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,157.2,40,,125.76,percent of total billed charges,40% of total billed charges,146.47,314.4,
OSMOPREP,6400014,CDM,250,RC,,,Outpatient,,,12.15,9.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.72,80,,7.78,percent of total billed charges,80% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% of total billed charges,4.53,37.27,,3.62,percent of total billed charges,37.27% 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,4.86,40,,3.89,percent of total billed charges,40% of total billed charges,4.53,9.72,
PRIMAXIN IM 500MG,6065130,CDM,636,RC,J0743,HCPCS,Outpatient,,,134.65,107.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.72,80,,86.18,percent of total billed charges,80% of total billed charges,50.18,37.27,,40.14,percent of total billed charges,37.27% of total billed charges,50.18,37.27,,40.14,percent of total billed charges,37.27% of total billed charges,50.18,37.27,,40.14,percent of total billed charges,37.27% 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,53.86,40,,43.09,percent of total billed charges,40% of total billed charges,50.18,107.72,
LAP HERNIA STAPLER,5801832,CDM,272,RC,,,Outpatient,,,479,383.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,383.2,80,,306.56,percent of total billed charges,80% of total billed charges,178.52,37.27,,142.82,percent of total billed charges,37.27% of total billed charges,178.52,37.27,,142.82,percent of total billed charges,37.27% of total billed charges,178.52,37.27,,142.82,percent of total billed charges,37.27% 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,191.6,40,,153.28,percent of total billed charges,40% of total billed charges,178.52,383.2,
MAXIPIME 1 GM INJ,6065130,CDM,636,RC,J0692,HCPCS,Outpatient,,,37.28,29.82,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.82,80,,23.86,percent of total billed charges,80% of total billed charges,13.89,37.27,,11.11,percent of total billed charges,37.27% of total billed charges,13.89,37.27,,11.11,percent of total billed charges,37.27% of total billed charges,13.89,37.27,,11.11,percent of total billed charges,37.27% 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,14.91,40,,11.93,percent of total billed charges,40% of total billed charges,13.89,29.82,
US AMNIOCENTESIS,6000566,CDM,402,RC,76946,HCPCS,Outpatient,,,720,576.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.58,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,40,,230.4,percent of total billed charges,40% of total billed charges,19.58,576,
VIDAZA INJ PER 1 MG,6065130,CDM,636,RC,J9025,HCPCS,Outpatient,,,17.55,14.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.04,80,,11.23,percent of total billed charges,80% of total billed charges,6.54,37.27,,5.23,percent of total billed charges,37.27% of total billed charges,6.54,37.27,,5.23,percent of total billed charges,37.27% of total billed charges,6.54,37.27,,5.23,percent of total billed charges,37.27% 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,7.02,40,,5.62,percent of total billed charges,40% of total billed charges,6.54,14.04,
PHOSLO 667MG CAP,6400014,CDM,250,RC,,,Outpatient,,,3.45,2.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.76,80,,2.21,percent of total billed charges,80% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% of total billed charges,1.29,37.27,,1.03,percent of total billed charges,37.27% 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,1.38,40,,1.1,percent of total billed charges,40% of total billed charges,1.29,2.76,
AMITIZA 24MCG CAP,6400014,CDM,250,RC,,,Outpatient,,,21.45,17.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.16,80,,13.73,percent of total billed charges,80% of total billed charges,7.99,37.27,,6.39,percent of total billed charges,37.27% of total billed charges,7.99,37.27,,6.39,percent of total billed charges,37.27% of total billed charges,7.99,37.27,,6.39,percent of total billed charges,37.27% 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,8.58,40,,6.86,percent of total billed charges,40% of total billed charges,7.99,17.16,
VOLTAREN 50,6400014,CDM,250,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
WHISKEY PER 4 OZ,6400014,CDM,250,RC,,,Outpatient,,,20.65,16.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.52,80,,13.22,percent of total billed charges,80% of total billed charges,7.7,37.27,,6.16,percent of total billed charges,37.27% of total billed charges,7.7,37.27,,6.16,percent of total billed charges,37.27% of total billed charges,7.7,37.27,,6.16,percent of total billed charges,37.27% 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,8.26,40,,6.61,percent of total billed charges,40% of total billed charges,7.7,16.52,
SPUTUM COLLECTION,7439094,CDM,410,RC,89220,HCPCS,Outpatient,,,165,132.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,24.65,145,,,fee schedule,145% of CMS fee schedule,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,40,,52.8,percent of total billed charges,40% of total billed charges,24.65,140.82,
CHLAMYDIA/NUCL ACID,7012032,CDM,300,RC,,,Outpatient,,,71.8,57.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.44,80,,45.95,percent of total billed charges,80% of total billed charges,26.76,37.27,,21.41,percent of total billed charges,37.27% of total billed charges,26.76,37.27,,21.41,percent of total billed charges,37.27% of total billed charges,26.76,37.27,,21.41,percent of total billed charges,37.27% 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,28.72,40,,22.98,percent of total billed charges,40% of total billed charges,26.76,57.44,
FROVA 2.5MG,6400014,CDM,250,RC,,,Outpatient,,,59.35,47.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.48,80,,37.98,percent of total billed charges,80% of total billed charges,22.12,37.27,,17.7,percent of total billed charges,37.27% of total billed charges,22.12,37.27,,17.7,percent of total billed charges,37.27% of total billed charges,22.12,37.27,,17.7,percent of total billed charges,37.27% 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,23.74,40,,18.99,percent of total billed charges,40% of total billed charges,22.12,47.48,
WOUND VAC ABD DRSSNG,5645742,CDM,270,RC,,,Outpatient,,,629,503.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,503.2,80,,402.56,percent of total billed charges,80% of total billed charges,234.43,37.27,,187.54,percent of total billed charges,37.27% of total billed charges,234.43,37.27,,187.54,percent of total billed charges,37.27% of total billed charges,234.43,37.27,,187.54,percent of total billed charges,37.27% 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,251.6,40,,201.28,percent of total billed charges,40% of total billed charges,234.43,503.2,
STALEVO 100,6400014,CDM,250,RC,,,Outpatient,,,31.25,25.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25,80,,20,percent of total billed charges,80% of total billed charges,11.65,37.27,,9.32,percent of total billed charges,37.27% of total billed charges,11.65,37.27,,9.32,percent of total billed charges,37.27% of total billed charges,11.65,37.27,,9.32,percent of total billed charges,37.27% 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,12.5,40,,10,percent of total billed charges,40% of total billed charges,11.65,25,
REQUIP 5MG,6400014,CDM,250,RC,,,Outpatient,,,10.9,8.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.72,80,,6.98,percent of total billed charges,80% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% 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,4.36,40,,3.49,percent of total billed charges,40% of total billed charges,4.06,8.72,
REQUIP 4MG TAB,6400014,CDM,250,RC,,,Outpatient,,,8.8,7.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.04,80,,5.63,percent of total billed charges,80% of total billed charges,3.28,37.27,,2.62,percent of total billed charges,37.27% of total billed charges,3.28,37.27,,2.62,percent of total billed charges,37.27% of total billed charges,3.28,37.27,,2.62,percent of total billed charges,37.27% 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,3.52,40,,2.82,percent of total billed charges,40% of total billed charges,3.28,7.04,
CARBAMAZEPINE 100 CH,6400014,CDM,250,RC,,,Outpatient,,,100,80.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% 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,40,40,,32,percent of total billed charges,40% of total billed charges,37.27,80,
MESH PROLENE 3D,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,583,466.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,466.4,80,,373.12,percent of total billed charges,80% of total billed charges,217.28,37.27,,173.82,percent of total billed charges,37.27% of total billed charges,217.28,37.27,,173.82,percent of total billed charges,37.27% of total billed charges,217.28,37.27,,173.82,percent of total billed charges,37.27% 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,233.2,40,,186.56,percent of total billed charges,40% of total billed charges,217.28,466.4,
VIT D3 1000IU,6400014,CDM,250,RC,,,Outpatient,,,5.45,4.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.36,80,,3.49,percent of total billed charges,80% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% 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,2.18,40,,1.74,percent of total billed charges,40% of total billed charges,2.03,4.36,
CHLORPHENIRAMINE 4MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
MESH 3D MAX MED L/R,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
FLUVOXAMINE 100MG TB,6400014,CDM,250,RC,,,Outpatient,,,8.95,7.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.16,80,,5.73,percent of total billed charges,80% of total billed charges,3.34,37.27,,2.67,percent of total billed charges,37.27% of total billed charges,3.34,37.27,,2.67,percent of total billed charges,37.27% of total billed charges,3.34,37.27,,2.67,percent of total billed charges,37.27% 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,3.58,40,,2.86,percent of total billed charges,40% of total billed charges,3.34,7.16,
CEFTIN 250MG/5ML,6400014,CDM,250,RC,,,Outpatient,,,215.6,172.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.48,80,,137.98,percent of total billed charges,80% of total billed charges,80.35,37.27,,64.28,percent of total billed charges,37.27% of total billed charges,80.35,37.27,,64.28,percent of total billed charges,37.27% of total billed charges,80.35,37.27,,64.28,percent of total billed charges,37.27% 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,86.24,40,,68.99,percent of total billed charges,40% of total billed charges,80.35,172.48,
PERGOLIDE 0.25MG,6400014,CDM,250,RC,,,Outpatient,,,6.35,5.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.08,80,,4.06,percent of total billed charges,80% of total billed charges,2.37,37.27,,1.9,percent of total billed charges,37.27% of total billed charges,2.37,37.27,,1.9,percent of total billed charges,37.27% of total billed charges,2.37,37.27,,1.9,percent of total billed charges,37.27% 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,2.54,40,,2.03,percent of total billed charges,40% of total billed charges,2.37,5.08,
MEXILETINE 150MG,6400014,CDM,250,RC,,,Outpatient,,,8.6,6.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.88,80,,5.5,percent of total billed charges,80% of total billed charges,3.21,37.27,,2.57,percent of total billed charges,37.27% of total billed charges,3.21,37.27,,2.57,percent of total billed charges,37.27% of total billed charges,3.21,37.27,,2.57,percent of total billed charges,37.27% 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,3.44,40,,2.75,percent of total billed charges,40% of total billed charges,3.21,6.88,
CAPTOPRIL/HCTZ 50/25,6400014,CDM,250,RC,,,Outpatient,,,4.65,3.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.72,80,,2.98,percent of total billed charges,80% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% of total billed charges,1.73,37.27,,1.38,percent of total billed charges,37.27% 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,1.86,40,,1.49,percent of total billed charges,40% of total billed charges,1.73,3.72,
APIDRA INJ PER ML,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,122.65,98.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.12,80,,78.5,percent of total billed charges,80% of total billed charges,45.71,37.27,,36.57,percent of total billed charges,37.27% of total billed charges,45.71,37.27,,36.57,percent of total billed charges,37.27% of total billed charges,45.71,37.27,,36.57,percent of total billed charges,37.27% 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,49.06,40,,39.25,percent of total billed charges,40% of total billed charges,45.71,98.12,
TRIVIT/FL 0.25 GTTS,6400014,CDM,250,RC,,,Outpatient,,,118.65,94.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.92,80,,75.94,percent of total billed charges,80% of total billed charges,44.22,37.27,,35.38,percent of total billed charges,37.27% of total billed charges,44.22,37.27,,35.38,percent of total billed charges,37.27% of total billed charges,44.22,37.27,,35.38,percent of total billed charges,37.27% 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,47.46,40,,37.97,percent of total billed charges,40% of total billed charges,44.22,94.92,
PAMINE FORTE 5MG,6400014,CDM,250,RC,,,Outpatient,,,16.5,13.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.2,80,,10.56,percent of total billed charges,80% of total billed charges,6.15,37.27,,4.92,percent of total billed charges,37.27% of total billed charges,6.15,37.27,,4.92,percent of total billed charges,37.27% of total billed charges,6.15,37.27,,4.92,percent of total billed charges,37.27% 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,6.6,40,,5.28,percent of total billed charges,40% of total billed charges,6.15,13.2,
AMPHOTERICIN B 50MG,6400014,CDM,250,RC,,,Outpatient,,,155.5,124.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.4,80,,99.52,percent of total billed charges,80% of total billed charges,57.95,37.27,,46.36,percent of total billed charges,37.27% of total billed charges,57.95,37.27,,46.36,percent of total billed charges,37.27% of total billed charges,57.95,37.27,,46.36,percent of total billed charges,37.27% 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,62.2,40,,49.76,percent of total billed charges,40% of total billed charges,57.95,124.4,
CYTOMEL 25MCG TAB,6400014,CDM,250,RC,,,Outpatient,,,10.85,8.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.68,80,,6.94,percent of total billed charges,80% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% 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,4.34,40,,3.47,percent of total billed charges,40% of total billed charges,4.04,8.68,
ULTRAM ER 100MG,6400014,CDM,250,RC,,,Outpatient,,,14.8,11.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.84,80,,9.47,percent of total billed charges,80% of total billed charges,5.52,37.27,,4.42,percent of total billed charges,37.27% of total billed charges,5.52,37.27,,4.42,percent of total billed charges,37.27% of total billed charges,5.52,37.27,,4.42,percent of total billed charges,37.27% 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,5.92,40,,4.74,percent of total billed charges,40% of total billed charges,5.52,11.84,
"VIT A 10,000 UN CAP",6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
LEVOTHYROXINE INJ,6400014,CDM,250,RC,,,Outpatient,,,82.5,66.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,80,,52.8,percent of total billed charges,80% of total billed charges,30.75,37.27,,24.6,percent of total billed charges,37.27% of total billed charges,30.75,37.27,,24.6,percent of total billed charges,37.27% of total billed charges,30.75,37.27,,24.6,percent of total billed charges,37.27% 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,33,40,,26.4,percent of total billed charges,40% of total billed charges,30.75,66,
ASPIRIN SUPP 5 GR,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
ARTHROTEC 75MG,6400014,CDM,250,RC,,,Outpatient,,,17.9,14.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.32,80,,11.46,percent of total billed charges,80% of total billed charges,6.67,37.27,,5.34,percent of total billed charges,37.27% of total billed charges,6.67,37.27,,5.34,percent of total billed charges,37.27% of total billed charges,6.67,37.27,,5.34,percent of total billed charges,37.27% 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,7.16,40,,5.73,percent of total billed charges,40% of total billed charges,6.67,14.32,
LESCOL 40MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,20.85,16.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.68,80,,13.34,percent of total billed charges,80% of total billed charges,7.77,37.27,,6.22,percent of total billed charges,37.27% of total billed charges,7.77,37.27,,6.22,percent of total billed charges,37.27% of total billed charges,7.77,37.27,,6.22,percent of total billed charges,37.27% 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,8.34,40,,6.67,percent of total billed charges,40% of total billed charges,7.77,16.68,
US GUIDED NEEDLE PLC,6000566,CDM,402,RC,76942,HCPCS,Outpatient,,,720,576.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.06,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,40,,230.4,percent of total billed charges,40% of total billed charges,36.06,576,
FLU ADMINISTRATION,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,27.21,58.4,
MARINOL 5MG CAP,6400014,CDM,250,RC,,,Outpatient,,,82.6,66.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.08,80,,52.86,percent of total billed charges,80% of total billed charges,30.79,37.27,,24.63,percent of total billed charges,37.27% of total billed charges,30.79,37.27,,24.63,percent of total billed charges,37.27% of total billed charges,30.79,37.27,,24.63,percent of total billed charges,37.27% 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,33.04,40,,26.43,percent of total billed charges,40% of total billed charges,30.79,66.08,
CLOPIDOGREL 75MG TAB,6400014,CDM,250,RC,,,Outpatient,,,14.95,11.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.96,80,,9.57,percent of total billed charges,80% of total billed charges,5.57,37.27,,4.46,percent of total billed charges,37.27% of total billed charges,5.57,37.27,,4.46,percent of total billed charges,37.27% of total billed charges,5.57,37.27,,4.46,percent of total billed charges,37.27% 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,5.98,40,,4.78,percent of total billed charges,40% of total billed charges,5.57,11.96,
BONIVA INJ PER 1 MG,6065130,CDM,636,RC,J1740,HCPCS,Outpatient,,,528.75,423.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,423,80,,338.4,percent of total billed charges,80% of total billed charges,197.07,37.27,,157.66,percent of total billed charges,37.27% of total billed charges,197.07,37.27,,157.66,percent of total billed charges,37.27% of total billed charges,197.07,37.27,,157.66,percent of total billed charges,37.27% 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,211.5,40,,169.2,percent of total billed charges,40% of total billed charges,197.07,423,
ZOFRAN 4MG TABLETS,6400014,CDM,250,RC,,,Outpatient,,,86.65,69.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.32,80,,55.46,percent of total billed charges,80% of total billed charges,32.29,37.27,,25.83,percent of total billed charges,37.27% of total billed charges,32.29,37.27,,25.83,percent of total billed charges,37.27% of total billed charges,32.29,37.27,,25.83,percent of total billed charges,37.27% 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,34.66,40,,27.73,percent of total billed charges,40% of total billed charges,32.29,69.32,
MUCINEX DM TAB,6400014,CDM,250,RC,,,Outpatient,,,2.1,1.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,80,,1.34,percent of total billed charges,80% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% 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,0.84,40,,0.67,percent of total billed charges,40% of total billed charges,0.78,1.68,
SPINAL MUSC AT PANEL,7012032,CDM,300,RC,,,Outpatient,,,180,144.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,80,,115.2,percent of total billed charges,80% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% 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,72,40,,57.6,percent of total billed charges,40% of total billed charges,67.09,144,
US AORTA SCREENING,6000566,CDM,402,RC,76706,HCPCS,Outpatient,,,262,209.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,209.6,80,,167.68,percent of total billed charges,80% of total billed charges,97.65,37.27,,78.12,percent of total billed charges,37.27% of total billed charges,97.65,37.27,,78.12,percent of total billed charges,37.27% of total billed charges,97.65,37.27,,78.12,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,102.86,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.8,40,,83.84,percent of total billed charges,40% of total billed charges,90.64,209.6,
MELATONIN 3MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
VINATE GT PRENATAL,6400014,CDM,250,RC,,,Outpatient,,,1.65,1.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.32,80,,1.06,percent of total billed charges,80% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% of total billed charges,0.61,37.27,,0.49,percent of total billed charges,37.27% 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,0.66,40,,0.53,percent of total billed charges,40% of total billed charges,0.61,1.32,
VINATE GT PRENATAL,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
FLUPHENAZINE 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,43.8,35.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.04,80,,28.03,percent of total billed charges,80% of total billed charges,16.32,37.27,,13.06,percent of total billed charges,37.27% of total billed charges,16.32,37.27,,13.06,percent of total billed charges,37.27% of total billed charges,16.32,37.27,,13.06,percent of total billed charges,37.27% 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,17.52,40,,14.02,percent of total billed charges,40% of total billed charges,16.32,35.04,
EXTENDRYL JR TAB,6400014,CDM,250,RC,,,Outpatient,,,2.1,1.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.68,80,,1.34,percent of total billed charges,80% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% of total billed charges,0.78,37.27,,0.62,percent of total billed charges,37.27% 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,0.84,40,,0.67,percent of total billed charges,40% of total billed charges,0.78,1.68,
POLY-HIST PD LIQUID,6400014,CDM,250,RC,,,Outpatient,,,12.8,10.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,80,,8.19,percent of total billed charges,80% of total billed charges,4.77,37.27,,3.82,percent of total billed charges,37.27% of total billed charges,4.77,37.27,,3.82,percent of total billed charges,37.27% of total billed charges,4.77,37.27,,3.82,percent of total billed charges,37.27% 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,5.12,40,,4.1,percent of total billed charges,40% of total billed charges,4.77,10.24,
RANEXA 500MG TAB,6400014,CDM,250,RC,,,Outpatient,,,28.05,22.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.44,80,,17.95,percent of total billed charges,80% of total billed charges,10.45,37.27,,8.36,percent of total billed charges,37.27% of total billed charges,10.45,37.27,,8.36,percent of total billed charges,37.27% of total billed charges,10.45,37.27,,8.36,percent of total billed charges,37.27% 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,11.22,40,,8.98,percent of total billed charges,40% of total billed charges,10.45,22.44,
CEFACLOR 250/5 75ML,6400014,CDM,250,RC,,,Outpatient,,,465,372.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,372,80,,297.6,percent of total billed charges,80% of total billed charges,173.31,37.27,,138.65,percent of total billed charges,37.27% of total billed charges,173.31,37.27,,138.65,percent of total billed charges,37.27% of total billed charges,173.31,37.27,,138.65,percent of total billed charges,37.27% 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,186,40,,148.8,percent of total billed charges,40% of total billed charges,173.31,372,
NAROPIN 2MG/ML 20ML,6065130,CDM,636,RC,J2795,HCPCS,Outpatient,,,37.7,30.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.16,80,,24.13,percent of total billed charges,80% of total billed charges,14.05,37.27,,11.24,percent of total billed charges,37.27% of total billed charges,14.05,37.27,,11.24,percent of total billed charges,37.27% of total billed charges,14.05,37.27,,11.24,percent of total billed charges,37.27% 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,15.08,40,,12.06,percent of total billed charges,40% of total billed charges,14.05,30.16,
NAROPIN 5MG/ML 30ML,6065130,CDM,636,RC,J2795,HCPCS,Outpatient,,,85.95,68.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.76,80,,55.01,percent of total billed charges,80% of total billed charges,32.03,37.27,,25.62,percent of total billed charges,37.27% of total billed charges,32.03,37.27,,25.62,percent of total billed charges,37.27% of total billed charges,32.03,37.27,,25.62,percent of total billed charges,37.27% 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,34.38,40,,27.5,percent of total billed charges,40% of total billed charges,32.03,68.76,
OXYCOD/APAP 5-500CAP,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
MAG SULF 50%VL 50ML,6065130,CDM,636,RC,J3475,HCPCS,Outpatient,,,57,45.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% 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,22.8,40,,18.24,percent of total billed charges,40% of total billed charges,21.24,45.6,
QVAR INHAL 40MCG,6400014,CDM,250,RC,,,Outpatient,,,227.05,181.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,181.64,80,,145.31,percent of total billed charges,80% of total billed charges,84.62,37.27,,67.7,percent of total billed charges,37.27% of total billed charges,84.62,37.27,,67.7,percent of total billed charges,37.27% of total billed charges,84.62,37.27,,67.7,percent of total billed charges,37.27% 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,90.82,40,,72.66,percent of total billed charges,40% of total billed charges,84.62,181.64,
VESICARE 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,52.6,42.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.08,80,,33.66,percent of total billed charges,80% of total billed charges,19.6,37.27,,15.68,percent of total billed charges,37.27% of total billed charges,19.6,37.27,,15.68,percent of total billed charges,37.27% of total billed charges,19.6,37.27,,15.68,percent of total billed charges,37.27% 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,21.04,40,,16.83,percent of total billed charges,40% of total billed charges,19.6,42.08,
GENTAMICIN 100MG PM,6065130,CDM,636,RC,J1580,HCPCS,Outpatient,,,82,65.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,30.56,37.27,,24.45,percent of total billed charges,37.27% of total billed charges,30.56,37.27,,24.45,percent of total billed charges,37.27% of total billed charges,30.56,37.27,,24.45,percent of total billed charges,37.27% 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,32.8,40,,26.24,percent of total billed charges,40% of total billed charges,30.56,65.6,
MAG SULF 4GM PREMIX,6065130,CDM,636,RC,J3475,HCPCS,Outpatient,,,38.95,31.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.16,80,,24.93,percent of total billed charges,80% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% 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,15.58,40,,12.46,percent of total billed charges,40% of total billed charges,14.52,31.16,
ORTHO-TRI-CYCLEN LO,6400014,CDM,250,RC,,,Outpatient,,,133.5,106.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.8,80,,85.44,percent of total billed charges,80% of total billed charges,49.76,37.27,,39.81,percent of total billed charges,37.27% of total billed charges,49.76,37.27,,39.81,percent of total billed charges,37.27% of total billed charges,49.76,37.27,,39.81,percent of total billed charges,37.27% 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,53.4,40,,42.72,percent of total billed charges,40% of total billed charges,49.76,106.8,
OB LEVEL OF CARE 1,8400010,CDM,760,RC,99211,HCPCS,Outpatient,,,146,116.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.19,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,12.19,116.8,
OB LEVEL OF CARE 2,8400010,CDM,760,RC,99212,HCPCS,Outpatient,,,210,168.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168,80,,134.4,percent of total billed charges,80% of total billed charges,78.27,37.27,,62.62,percent of total billed charges,37.27% of total billed charges,78.27,37.27,,62.62,percent of total billed charges,37.27% of total billed charges,78.27,37.27,,62.62,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.36,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,40,,67.2,percent of total billed charges,40% of total billed charges,49.36,168,
OB LEVEL OF CARE 3,8400010,CDM,760,RC,99213,HCPCS,Outpatient,,,219,175.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.2,80,,140.16,percent of total billed charges,80% of total billed charges,81.62,37.27,,65.3,percent of total billed charges,37.27% of total billed charges,81.62,37.27,,65.3,percent of total billed charges,37.27% of total billed charges,81.62,37.27,,65.3,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.94,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.6,40,,70.08,percent of total billed charges,40% of total billed charges,81.62,175.2,
OB LEVEL OF CARE 4,8400010,CDM,760,RC,99214,HCPCS,Outpatient,,,279,223.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,223.2,80,,178.56,percent of total billed charges,80% of total billed charges,103.98,37.27,,83.18,percent of total billed charges,37.27% of total billed charges,103.98,37.27,,83.18,percent of total billed charges,37.27% of total billed charges,103.98,37.27,,83.18,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.49,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.6,40,,89.28,percent of total billed charges,40% of total billed charges,103.98,223.2,
OB LEVEL OF CARE 5,8400010,CDM,760,RC,99215,HCPCS,Outpatient,,,360,288.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,134.17,37.27,,107.34,percent of total billed charges,37.27% of total billed charges,134.17,37.27,,107.34,percent of total billed charges,37.27% of total billed charges,134.17,37.27,,107.34,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.98,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,40,,115.2,percent of total billed charges,40% of total billed charges,134.17,288,
FLORASTOR 250MG CAP,6400014,CDM,250,RC,,,Outpatient,,,3.9,3.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.12,80,,2.5,percent of total billed charges,80% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% of total billed charges,1.45,37.27,,1.16,percent of total billed charges,37.27% 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,1.56,40,,1.25,percent of total billed charges,40% of total billed charges,1.45,3.12,
ALLERX-DF DOSEPAK,6400014,CDM,250,RC,,,Outpatient,,,38.75,31.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31,80,,24.8,percent of total billed charges,80% of total billed charges,14.44,37.27,,11.55,percent of total billed charges,37.27% of total billed charges,14.44,37.27,,11.55,percent of total billed charges,37.27% of total billed charges,14.44,37.27,,11.55,percent of total billed charges,37.27% 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,15.5,40,,12.4,percent of total billed charges,40% of total billed charges,14.44,31,
CT/NG AMPLIFIED PROB,7012032,CDM,300,RC,,,Outpatient,,,195.28,156.22,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.22,80,,124.98,percent of total billed charges,80% of total billed charges,72.78,37.27,,58.22,percent of total billed charges,37.27% of total billed charges,72.78,37.27,,58.22,percent of total billed charges,37.27% of total billed charges,72.78,37.27,,58.22,percent of total billed charges,37.27% 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,78.11,40,,62.49,percent of total billed charges,40% of total billed charges,72.78,156.22,
CORTANE B LOTION,6400014,CDM,250,RC,,,Outpatient,,,218.89,175.11,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.11,80,,140.09,percent of total billed charges,80% of total billed charges,81.58,37.27,,65.26,percent of total billed charges,37.27% of total billed charges,81.58,37.27,,65.26,percent of total billed charges,37.27% of total billed charges,81.58,37.27,,65.26,percent of total billed charges,37.27% 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,87.56,40,,70.05,percent of total billed charges,40% of total billed charges,81.58,175.11,
DISOPYRAMIDE 100MG C,6400014,CDM,250,RC,,,Outpatient,,,9.7,7.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.76,80,,6.21,percent of total billed charges,80% of total billed charges,3.62,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.62,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.62,37.27,,2.9,percent of total billed charges,37.27% 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,3.88,40,,3.1,percent of total billed charges,40% of total billed charges,3.62,7.76,
TRIAM CR 0.1% 80GM,6400014,CDM,250,RC,,,Outpatient,,,20.65,16.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.52,80,,13.22,percent of total billed charges,80% of total billed charges,7.7,37.27,,6.16,percent of total billed charges,37.27% of total billed charges,7.7,37.27,,6.16,percent of total billed charges,37.27% of total billed charges,7.7,37.27,,6.16,percent of total billed charges,37.27% 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,8.26,40,,6.61,percent of total billed charges,40% of total billed charges,7.7,16.52,
CALAMINE LOTION,6400014,CDM,250,RC,,,Outpatient,,,5.35,4.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.28,80,,3.42,percent of total billed charges,80% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% of total billed charges,1.99,37.27,,1.59,percent of total billed charges,37.27% 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,2.14,40,,1.71,percent of total billed charges,40% of total billed charges,1.99,4.28,
HEMOCYTE TAB 324MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
TESTOSTERONE 200MG,6400014,CDM,250,RC,,,Outpatient,,,263.35,210.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.68,80,,168.54,percent of total billed charges,80% of total billed charges,98.15,37.27,,78.52,percent of total billed charges,37.27% of total billed charges,98.15,37.27,,78.52,percent of total billed charges,37.27% of total billed charges,98.15,37.27,,78.52,percent of total billed charges,37.27% 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,105.34,40,,84.27,percent of total billed charges,40% of total billed charges,98.15,210.68,
NASAL MAC SAFE CANNU,5645742,CDM,270,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
US PREG TRANSAB >/=1,6000566,CDM,402,RC,76810,HCPCS,Outpatient,,,720,576.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.55,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,40,,230.4,percent of total billed charges,40% of total billed charges,52.55,576,
GYNAZOLE-1 2% VAG.CM,6400014,CDM,250,RC,,,Outpatient,,,182.05,145.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.64,80,,116.51,percent of total billed charges,80% of total billed charges,67.85,37.27,,54.28,percent of total billed charges,37.27% of total billed charges,67.85,37.27,,54.28,percent of total billed charges,37.27% of total billed charges,67.85,37.27,,54.28,percent of total billed charges,37.27% 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,72.82,40,,58.26,percent of total billed charges,40% of total billed charges,67.85,145.64,
HALFLYTELY KIT,6400014,CDM,250,RC,,,Outpatient,,,169.35,135.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.48,80,,108.38,percent of total billed charges,80% of total billed charges,63.12,37.27,,50.5,percent of total billed charges,37.27% of total billed charges,63.12,37.27,,50.5,percent of total billed charges,37.27% of total billed charges,63.12,37.27,,50.5,percent of total billed charges,37.27% 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,67.74,40,,54.19,percent of total billed charges,40% of total billed charges,63.12,135.48,
NORTRIPTYLINE 10MG,6400014,CDM,250,RC,,,Outpatient,,,2.5,2.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
MERCUROCLEAR SOLN.,6400014,CDM,250,RC,,,Outpatient,,,8.4,6.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.72,80,,5.38,percent of total billed charges,80% of total billed charges,3.13,37.27,,2.5,percent of total billed charges,37.27% of total billed charges,3.13,37.27,,2.5,percent of total billed charges,37.27% of total billed charges,3.13,37.27,,2.5,percent of total billed charges,37.27% 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,3.36,40,,2.69,percent of total billed charges,40% of total billed charges,3.13,6.72,
TERBUTALINE 2.5MG TB,6400014,CDM,250,RC,,,Outpatient,,,18.55,14.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.84,80,,11.87,percent of total billed charges,80% of total billed charges,6.91,37.27,,5.53,percent of total billed charges,37.27% of total billed charges,6.91,37.27,,5.53,percent of total billed charges,37.27% of total billed charges,6.91,37.27,,5.53,percent of total billed charges,37.27% 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,7.42,40,,5.94,percent of total billed charges,40% of total billed charges,6.91,14.84,
DIHYDROTESTOSTERONE,7000029,CDM,301,RC,80327,HCPCS,Outpatient,,,133,106.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% 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,53.2,40,,42.56,percent of total billed charges,40% of total billed charges,49.57,106.4,
METROGEL 1% 60 GM,6400014,CDM,250,RC,,,Outpatient,,,1314.55,1051.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1051.64,80,,841.31,percent of total billed charges,80% of total billed charges,489.93,37.27,,391.94,percent of total billed charges,37.27% of total billed charges,489.93,37.27,,391.94,percent of total billed charges,37.27% of total billed charges,489.93,37.27,,391.94,percent of total billed charges,37.27% 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,525.82,40,,420.66,percent of total billed charges,40% of total billed charges,489.93,1051.64,
PROCAINAMIDE INJ VL,6065130,CDM,636,RC,J2690,HCPCS,Outpatient,,,376.7,301.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,301.36,80,,241.09,percent of total billed charges,80% of total billed charges,140.4,37.27,,112.32,percent of total billed charges,37.27% of total billed charges,140.4,37.27,,112.32,percent of total billed charges,37.27% of total billed charges,140.4,37.27,,112.32,percent of total billed charges,37.27% of total billed charges,546.07,100,,,fee schedule,100% of APC rate,546.07,100,,,fee schedule,100% of APC rate,546.07,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,546.07,100,,,fee schedule,100% of APC rate,546.07,100,,,fee schedule,100% of APC rate,546.07,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.68,40,,120.54,percent of total billed charges,40% of total billed charges,140.4,546.07,
ISUPREL INJ 5ML,6400014,CDM,250,RC,,,Outpatient,,,2986.3,2389.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2389.04,80,,1911.23,percent of total billed charges,80% of total billed charges,1112.99,37.27,,890.39,percent of total billed charges,37.27% of total billed charges,1112.99,37.27,,890.39,percent of total billed charges,37.27% of total billed charges,1112.99,37.27,,890.39,percent of total billed charges,37.27% 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,1194.52,40,,955.62,percent of total billed charges,40% of total billed charges,1112.99,2389.04,
MOVIPREP KIT,5880901,CDM,637,RC,,,Outpatient,,,515.1,412.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412.08,80,,329.66,percent of total billed charges,80% of total billed charges,191.98,37.27,,153.58,percent of total billed charges,37.27% of total billed charges,191.98,37.27,,153.58,percent of total billed charges,37.27% of total billed charges,191.98,37.27,,153.58,percent of total billed charges,37.27% 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,206.04,40,,164.83,percent of total billed charges,40% of total billed charges,191.98,412.08,
IMITREX NAS SPY 20MG,6400014,CDM,250,RC,,,Outpatient,,,155.95,124.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.76,80,,99.81,percent of total billed charges,80% of total billed charges,58.12,37.27,,46.5,percent of total billed charges,37.27% of total billed charges,58.12,37.27,,46.5,percent of total billed charges,37.27% of total billed charges,58.12,37.27,,46.5,percent of total billed charges,37.27% 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,62.38,40,,49.9,percent of total billed charges,40% of total billed charges,58.12,124.76,
DROXIA 200MG CAP,6400014,CDM,250,RC,,,Outpatient,,,3.1,2.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.48,80,,1.98,percent of total billed charges,80% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% 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,1.24,40,,0.99,percent of total billed charges,40% of total billed charges,1.16,2.48,
COREG CR 10MG CAP,6400014,CDM,250,RC,,,Outpatient,,,37.55,30.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.04,80,,24.03,percent of total billed charges,80% of total billed charges,13.99,37.27,,11.19,percent of total billed charges,37.27% of total billed charges,13.99,37.27,,11.19,percent of total billed charges,37.27% of total billed charges,13.99,37.27,,11.19,percent of total billed charges,37.27% 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,15.02,40,,12.02,percent of total billed charges,40% of total billed charges,13.99,30.04,
VIAGRA 25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,76.7,61.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.36,80,,49.09,percent of total billed charges,80% of total billed charges,28.59,37.27,,22.87,percent of total billed charges,37.27% of total billed charges,28.59,37.27,,22.87,percent of total billed charges,37.27% of total billed charges,28.59,37.27,,22.87,percent of total billed charges,37.27% 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,30.68,40,,24.54,percent of total billed charges,40% of total billed charges,28.59,61.36,
VIAGRA 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,131.8,105.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.44,80,,84.35,percent of total billed charges,80% of total billed charges,49.12,37.27,,39.3,percent of total billed charges,37.27% of total billed charges,49.12,37.27,,39.3,percent of total billed charges,37.27% of total billed charges,49.12,37.27,,39.3,percent of total billed charges,37.27% 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,52.72,40,,42.18,percent of total billed charges,40% of total billed charges,49.12,105.44,
VFEND INJ PER 10MG,6065130,CDM,636,RC,J3465,HCPCS,Outpatient,,,30.53,24.42,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.42,80,,19.54,percent of total billed charges,80% of total billed charges,11.38,37.27,,9.1,percent of total billed charges,37.27% of total billed charges,11.38,37.27,,9.1,percent of total billed charges,37.27% of total billed charges,11.38,37.27,,9.1,percent of total billed charges,37.27% 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,12.21,40,,9.77,percent of total billed charges,40% of total billed charges,11.38,24.42,
IMMUNOFIX/PE CSF,7012032,CDM,300,RC,,,Outpatient,,,255,204.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204,80,,163.2,percent of total billed charges,80% of total billed charges,95.04,37.27,,76.03,percent of total billed charges,37.27% of total billed charges,95.04,37.27,,76.03,percent of total billed charges,37.27% of total billed charges,95.04,37.27,,76.03,percent of total billed charges,37.27% 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,102,40,,81.6,percent of total billed charges,40% of total billed charges,95.04,204,
LOTREL 5-20MG,6400014,CDM,250,RC,,,Outpatient,,,10.45,8.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.36,80,,6.69,percent of total billed charges,80% of total billed charges,3.89,37.27,,3.11,percent of total billed charges,37.27% of total billed charges,3.89,37.27,,3.11,percent of total billed charges,37.27% of total billed charges,3.89,37.27,,3.11,percent of total billed charges,37.27% 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,4.18,40,,3.34,percent of total billed charges,40% of total billed charges,3.89,8.36,
PHENYTOIN 250MG INJ,6065130,CDM,636,RC,J1165,HCPCS,Outpatient,,,15.45,12.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.36,80,,9.89,percent of total billed charges,80% of total billed charges,5.76,37.27,,4.61,percent of total billed charges,37.27% of total billed charges,5.76,37.27,,4.61,percent of total billed charges,37.27% of total billed charges,5.76,37.27,,4.61,percent of total billed charges,37.27% 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,6.18,40,,4.94,percent of total billed charges,40% of total billed charges,5.76,12.36,
COREG CR 20MG,6400014,CDM,250,RC,,,Outpatient,,,37.55,30.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.04,80,,24.03,percent of total billed charges,80% of total billed charges,13.99,37.27,,11.19,percent of total billed charges,37.27% of total billed charges,13.99,37.27,,11.19,percent of total billed charges,37.27% of total billed charges,13.99,37.27,,11.19,percent of total billed charges,37.27% 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,15.02,40,,12.02,percent of total billed charges,40% of total billed charges,13.99,30.04,
NEORAL 25MG CAP,6065130,CDM,636,RC,J7515,HCPCS,Outpatient,,,6.3,5.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,80,,4.03,percent of total billed charges,80% of total billed charges,2.35,37.27,,1.88,percent of total billed charges,37.27% of total billed charges,2.35,37.27,,1.88,percent of total billed charges,37.27% of total billed charges,2.35,37.27,,1.88,percent of total billed charges,37.27% 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,2.52,40,,2.02,percent of total billed charges,40% of total billed charges,2.35,5.04,
CYCLOSPORIN 100MG CP,6065130,CDM,636,RC,J7502,HCPCS,Outpatient,,,18.7,14.96,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.96,80,,11.97,percent of total billed charges,80% of total billed charges,6.97,37.27,,5.58,percent of total billed charges,37.27% of total billed charges,6.97,37.27,,5.58,percent of total billed charges,37.27% of total billed charges,6.97,37.27,,5.58,percent of total billed charges,37.27% 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,7.48,40,,5.98,percent of total billed charges,40% of total billed charges,6.97,14.96,
REQUIP 4MG TAB,6400014,CDM,250,RC,,,Outpatient,,,10.9,8.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.72,80,,6.98,percent of total billed charges,80% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% 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,4.36,40,,3.49,percent of total billed charges,40% of total billed charges,4.06,8.72,
XIGRIS 20MG VL,6400014,CDM,250,RC,,,Outpatient,,,3829.2,3063.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3063.36,80,,2450.69,percent of total billed charges,80% of total billed charges,1427.14,37.27,,1141.71,percent of total billed charges,37.27% of total billed charges,1427.14,37.27,,1141.71,percent of total billed charges,37.27% of total billed charges,1427.14,37.27,,1141.71,percent of total billed charges,37.27% 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,1531.68,40,,1225.34,percent of total billed charges,40% of total billed charges,1427.14,3063.36,
CLEMASTINE 1.34MG TA,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ALBUTEROL 2MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
TEKTURNA 150MG TAB,6400014,CDM,250,RC,,,Outpatient,,,43.2,34.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.56,80,,27.65,percent of total billed charges,80% of total billed charges,16.1,37.27,,12.88,percent of total billed charges,37.27% of total billed charges,16.1,37.27,,12.88,percent of total billed charges,37.27% of total billed charges,16.1,37.27,,12.88,percent of total billed charges,37.27% 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,17.28,40,,13.82,percent of total billed charges,40% of total billed charges,16.1,34.56,
CAMPRAL DR 333MG TAB,6400014,CDM,250,RC,,,Outpatient,,,5.95,4.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.76,80,,3.81,percent of total billed charges,80% of total billed charges,2.22,37.27,,1.78,percent of total billed charges,37.27% of total billed charges,2.22,37.27,,1.78,percent of total billed charges,37.27% of total billed charges,2.22,37.27,,1.78,percent of total billed charges,37.27% 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,2.38,40,,1.9,percent of total billed charges,40% of total billed charges,2.22,4.76,
COUGH DROP SUGAR FRE,6400014,CDM,250,RC,,,Outpatient,,,7.15,5.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.72,80,,4.58,percent of total billed charges,80% of total billed charges,2.66,37.27,,2.13,percent of total billed charges,37.27% of total billed charges,2.66,37.27,,2.13,percent of total billed charges,37.27% of total billed charges,2.66,37.27,,2.13,percent of total billed charges,37.27% 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,2.86,40,,2.29,percent of total billed charges,40% of total billed charges,2.66,5.72,
DERMATOP CRM 0.1%,6400014,CDM,250,RC,,,Outpatient,,,82.45,65.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.96,80,,52.77,percent of total billed charges,80% of total billed charges,30.73,37.27,,24.58,percent of total billed charges,37.27% of total billed charges,30.73,37.27,,24.58,percent of total billed charges,37.27% of total billed charges,30.73,37.27,,24.58,percent of total billed charges,37.27% 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,32.98,40,,26.38,percent of total billed charges,40% of total billed charges,30.73,65.96,
CAPEX SHAMPOO 4OZ,6400014,CDM,250,RC,,,Outpatient,,,11.85,9.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.48,80,,7.58,percent of total billed charges,80% of total billed charges,4.42,37.27,,3.54,percent of total billed charges,37.27% of total billed charges,4.42,37.27,,3.54,percent of total billed charges,37.27% of total billed charges,4.42,37.27,,3.54,percent of total billed charges,37.27% 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,4.74,40,,3.79,percent of total billed charges,40% of total billed charges,4.42,9.48,
NEUTRA-PHOS PKT.,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
KOGENATE FS PER UNIT,6065130,CDM,636,RC,J7190,HCPCS,Outpatient,,,5.7,4.56,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.56,80,,3.65,percent of total billed charges,80% of total billed charges,2.12,37.27,,1.7,percent of total billed charges,37.27% of total billed charges,2.12,37.27,,1.7,percent of total billed charges,37.27% of total billed charges,2.12,37.27,,1.7,percent of total billed charges,37.27% of total billed charges,1.17,100,,,fee schedule,100% of APC rate,1.17,100,,,fee schedule,100% of APC rate,1.17,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1.17,100,,,fee schedule,100% of APC rate,1.17,100,,,fee schedule,100% of APC rate,1.17,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.28,40,,1.82,percent of total billed charges,40% of total billed charges,1.17,4.56,
KETOCONAZOLE SHAMPOO,6400014,CDM,250,RC,,,Outpatient,,,94.05,75.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.24,80,,60.19,percent of total billed charges,80% of total billed charges,35.05,37.27,,28.04,percent of total billed charges,37.27% of total billed charges,35.05,37.27,,28.04,percent of total billed charges,37.27% of total billed charges,35.05,37.27,,28.04,percent of total billed charges,37.27% 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,37.62,40,,30.1,percent of total billed charges,40% of total billed charges,35.05,75.24,
TRILEPTAL SUSP (OZ),6400014,CDM,250,RC,,,Outpatient,,,162.7,130.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.16,80,,104.13,percent of total billed charges,80% of total billed charges,60.64,37.27,,48.51,percent of total billed charges,37.27% of total billed charges,60.64,37.27,,48.51,percent of total billed charges,37.27% of total billed charges,60.64,37.27,,48.51,percent of total billed charges,37.27% 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,65.08,40,,52.06,percent of total billed charges,40% of total billed charges,60.64,130.16,
DEB SEL ADDL 20SQCM,5612346,CDM,761,RC,97598,HCPCS,Outpatient,,,176,140.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.63,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,40,,56.32,percent of total billed charges,40% of total billed charges,34.63,140.8,
DEB NONSEL 1 SESS,5612353,CDM,510,RC,97602,HCPCS,Outpatient,,,252,201.60,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,201.6,80,,161.28,percent of total billed charges,80% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,93.92,201.6,
DEB SEL 20SQCM/<,5612346,CDM,761,RC,97597,HCPCS,Outpatient,,,440,352.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352,80,,281.6,percent of total billed charges,80% of total billed charges,163.99,37.27,,131.19,percent of total billed charges,37.27% of total billed charges,163.99,37.27,,131.19,percent of total billed charges,37.27% of total billed charges,163.99,37.27,,131.19,percent of total billed charges,37.27% of total billed charges,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,49.78,145,,,fee schedule,145% of CMS fee schedule,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176,40,,140.8,percent of total billed charges,40% of total billed charges,49.78,352,
LEUKERAN 2MG TAB,6400014,CDM,250,RC,,,Outpatient,,,17.4,13.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.92,80,,11.14,percent of total billed charges,80% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% 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,6.96,40,,5.57,percent of total billed charges,40% of total billed charges,6.48,13.92,
CLINDESS VAG CR 2%,6400014,CDM,250,RC,,,Outpatient,,,513,410.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,410.4,80,,328.32,percent of total billed charges,80% of total billed charges,191.2,37.27,,152.96,percent of total billed charges,37.27% of total billed charges,191.2,37.27,,152.96,percent of total billed charges,37.27% of total billed charges,191.2,37.27,,152.96,percent of total billed charges,37.27% 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,205.2,40,,164.16,percent of total billed charges,40% of total billed charges,191.2,410.4,
VAGINITIS/VAG DNA PR,7012032,CDM,300,RC,,,Outpatient,,,339,271.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,271.2,80,,216.96,percent of total billed charges,80% of total billed charges,126.35,37.27,,101.08,percent of total billed charges,37.27% of total billed charges,126.35,37.27,,101.08,percent of total billed charges,37.27% of total billed charges,126.35,37.27,,101.08,percent of total billed charges,37.27% 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,135.6,40,,108.48,percent of total billed charges,40% of total billed charges,126.35,271.2,
MESNA 1000MG VL,6065130,CDM,636,RC,J9209,HCPCS,Outpatient,,,122.1,97.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.68,80,,78.14,percent of total billed charges,80% of total billed charges,45.51,37.27,,36.41,percent of total billed charges,37.27% of total billed charges,45.51,37.27,,36.41,percent of total billed charges,37.27% of total billed charges,45.51,37.27,,36.41,percent of total billed charges,37.27% 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,48.84,40,,39.07,percent of total billed charges,40% of total billed charges,45.51,97.68,
VIRAMUNE SUSP.,6400014,CDM,250,RC,,,Outpatient,,,84.25,67.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.4,80,,53.92,percent of total billed charges,80% of total billed charges,31.4,37.27,,25.12,percent of total billed charges,37.27% of total billed charges,31.4,37.27,,25.12,percent of total billed charges,37.27% of total billed charges,31.4,37.27,,25.12,percent of total billed charges,37.27% 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,33.7,40,,26.96,percent of total billed charges,40% of total billed charges,31.4,67.4,
RETROVIR SYRUP,6400014,CDM,250,RC,,,Outpatient,,,33.1,26.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.48,80,,21.18,percent of total billed charges,80% of total billed charges,12.34,37.27,,9.87,percent of total billed charges,37.27% of total billed charges,12.34,37.27,,9.87,percent of total billed charges,37.27% of total billed charges,12.34,37.27,,9.87,percent of total billed charges,37.27% 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,13.24,40,,10.59,percent of total billed charges,40% of total billed charges,12.34,26.48,
LYRICA 200MG CAP,6400014,CDM,250,RC,,,Outpatient,,,10.85,8.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.68,80,,6.94,percent of total billed charges,80% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% 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,4.34,40,,3.47,percent of total billed charges,40% of total billed charges,4.04,8.68,
LYRICA 100MG CAP,6400014,CDM,250,RC,,,Outpatient,,,10.85,8.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.68,80,,6.94,percent of total billed charges,80% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% of total billed charges,4.04,37.27,,3.23,percent of total billed charges,37.27% 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,4.34,40,,3.47,percent of total billed charges,40% of total billed charges,4.04,8.68,
JANUVIA 100MG TAB,6400014,CDM,250,RC,,,Outpatient,,,78.15,62.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.52,80,,50.02,percent of total billed charges,80% of total billed charges,29.13,37.27,,23.3,percent of total billed charges,37.27% of total billed charges,29.13,37.27,,23.3,percent of total billed charges,37.27% of total billed charges,29.13,37.27,,23.3,percent of total billed charges,37.27% 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,31.26,40,,25.01,percent of total billed charges,40% of total billed charges,29.13,62.52,
PROTEIN C DEFIC PROF,7012032,CDM,300,RC,,,Outpatient,,,414,331.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,331.2,80,,264.96,percent of total billed charges,80% of total billed charges,154.3,37.27,,123.44,percent of total billed charges,37.27% of total billed charges,154.3,37.27,,123.44,percent of total billed charges,37.27% of total billed charges,154.3,37.27,,123.44,percent of total billed charges,37.27% 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,165.6,40,,132.48,percent of total billed charges,40% of total billed charges,154.3,331.2,
PROTEIN S DEFIC PROF,7012032,CDM,300,RC,,,Outpatient,,,665,532.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,532,80,,425.6,percent of total billed charges,80% of total billed charges,247.85,37.27,,198.28,percent of total billed charges,37.27% of total billed charges,247.85,37.27,,198.28,percent of total billed charges,37.27% of total billed charges,247.85,37.27,,198.28,percent of total billed charges,37.27% 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,266,40,,212.8,percent of total billed charges,40% of total billed charges,247.85,532,
DROXIA 300MG CAP,6400014,CDM,250,RC,,,Outpatient,,,3.1,2.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.48,80,,1.98,percent of total billed charges,80% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% 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,1.24,40,,0.99,percent of total billed charges,40% of total billed charges,1.16,2.48,
BLEPHAMIDE OPTH SUSP,5880901,CDM,637,RC,,,Outpatient,,,310.8,248.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,248.64,80,,198.91,percent of total billed charges,80% of total billed charges,115.84,37.27,,92.67,percent of total billed charges,37.27% of total billed charges,115.84,37.27,,92.67,percent of total billed charges,37.27% of total billed charges,115.84,37.27,,92.67,percent of total billed charges,37.27% 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,124.32,40,,99.46,percent of total billed charges,40% of total billed charges,115.84,248.64,
ACTICIN 5% CRM 60GM,6400014,CDM,250,RC,,,Outpatient,,,540.15,432.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,432.12,80,,345.7,percent of total billed charges,80% of total billed charges,201.31,37.27,,161.05,percent of total billed charges,37.27% of total billed charges,201.31,37.27,,161.05,percent of total billed charges,37.27% of total billed charges,201.31,37.27,,161.05,percent of total billed charges,37.27% 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,216.06,40,,172.85,percent of total billed charges,40% of total billed charges,201.31,432.12,
EURAX LOTION,6400014,CDM,250,RC,,,Outpatient,,,490.15,392.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,392.12,80,,313.7,percent of total billed charges,80% of total billed charges,182.68,37.27,,146.14,percent of total billed charges,37.27% of total billed charges,182.68,37.27,,146.14,percent of total billed charges,37.27% of total billed charges,182.68,37.27,,146.14,percent of total billed charges,37.27% 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,196.06,40,,156.85,percent of total billed charges,40% of total billed charges,182.68,392.12,
ZYRTEC SYRUP PER 5ML,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
MINOCYCLINE 100MG CP,6400014,CDM,250,RC,,,Outpatient,,,13.25,10.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.6,80,,8.48,percent of total billed charges,80% of total billed charges,4.94,37.27,,3.95,percent of total billed charges,37.27% of total billed charges,4.94,37.27,,3.95,percent of total billed charges,37.27% of total billed charges,4.94,37.27,,3.95,percent of total billed charges,37.27% 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,5.3,40,,4.24,percent of total billed charges,40% of total billed charges,4.94,10.6,
HEPATITIS B PROFILE,7012032,CDM,300,RC,,,Outpatient,,,316,252.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% 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,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,117.77,252.8,
AUGMENTIN SUSP 250MG,6400014,CDM,250,RC,,,Outpatient,,,450,360.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360,80,,288,percent of total billed charges,80% of total billed charges,167.72,37.27,,134.18,percent of total billed charges,37.27% of total billed charges,167.72,37.27,,134.18,percent of total billed charges,37.27% of total billed charges,167.72,37.27,,134.18,percent of total billed charges,37.27% 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,180,40,,144,percent of total billed charges,40% of total billed charges,167.72,360,
METHADONE,7000029,CDM,301,RC,80358,HCPCS,Outpatient,,,228.86,183.09,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.09,80,,146.47,percent of total billed charges,80% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% 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,91.54,40,,73.23,percent of total billed charges,40% of total billed charges,85.3,183.09,
CEREFOLIN TAB,6400014,CDM,250,RC,,,Outpatient,,,11.2,8.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.96,80,,7.17,percent of total billed charges,80% of total billed charges,4.17,37.27,,3.34,percent of total billed charges,37.27% of total billed charges,4.17,37.27,,3.34,percent of total billed charges,37.27% of total billed charges,4.17,37.27,,3.34,percent of total billed charges,37.27% 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,4.48,40,,3.58,percent of total billed charges,40% of total billed charges,4.17,8.96,
EXELON 6MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,23.4,18.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.72,80,,14.98,percent of total billed charges,80% of total billed charges,8.72,37.27,,6.98,percent of total billed charges,37.27% of total billed charges,8.72,37.27,,6.98,percent of total billed charges,37.27% of total billed charges,8.72,37.27,,6.98,percent of total billed charges,37.27% 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,9.36,40,,7.49,percent of total billed charges,40% of total billed charges,8.72,18.72,
RECLAST 5MG/100ML VL,6065130,CDM,636,RC,J3489,HCPCS,Outpatient,,,650.3,520.24,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520.24,80,,416.19,percent of total billed charges,80% of total billed charges,242.37,37.27,,193.9,percent of total billed charges,37.27% of total billed charges,242.37,37.27,,193.9,percent of total billed charges,37.27% of total billed charges,242.37,37.27,,193.9,percent of total billed charges,37.27% 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,260.12,40,,208.1,percent of total billed charges,40% of total billed charges,242.37,520.24,
FLU VACCINE ADM FEE,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,27.21,58.4,
LIPO PROFILE,7012032,CDM,300,RC,,,Outpatient,,,196,156.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% 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,78.4,40,,62.72,percent of total billed charges,40% of total billed charges,73.05,156.8,
ANTIGEN TYPE GRP IV,7000169,CDM,302,RC,86905,HCPCS,Outpatient,,,225,180.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,80,,144,percent of total billed charges,80% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,3.83,100,,,fee schedule,100% of CMS fee schedule,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90,40,,72,percent of total billed charges,40% of total billed charges,3.83,296.36,
ANTIGEN TYPE GRP III,7000169,CDM,302,RC,86905,HCPCS,Outpatient,,,430.86,344.69,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344.69,80,,275.75,percent of total billed charges,80% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,3.83,100,,,fee schedule,100% of CMS fee schedule,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.34,40,,137.87,percent of total billed charges,40% of total billed charges,3.83,344.69,
ANTIGEN TYPE GR II,7000169,CDM,302,RC,86905,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,3.83,100,,,fee schedule,100% of CMS fee schedule,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,3.83,296.36,
LBC RH PHENOTYPE,7000169,CDM,302,RC,86906,HCPCS,Outpatient,,,214,171.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,79.76,37.27,,63.81,percent of total billed charges,37.27% of total billed charges,79.76,37.27,,63.81,percent of total billed charges,37.27% of total billed charges,79.76,37.27,,63.81,percent of total billed charges,37.27% of total billed charges,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,7.75,100,,,fee schedule,100% of CMS fee schedule,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.6,40,,68.48,percent of total billed charges,40% of total billed charges,7.75,171.2,
LBC PREWARM SCREEN,7000169,CDM,302,RC,86850,HCPCS,Outpatient,,,203,162.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,9.77,100,,,fee schedule,100% of CMS fee schedule,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.2,40,,64.96,percent of total billed charges,40% of total billed charges,9.77,162.4,
CYANIDE ANTIDOTE KIT,6400014,CDM,250,RC,,,Outpatient,,,1383.65,1106.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1106.92,80,,885.54,percent of total billed charges,80% of total billed charges,515.69,37.27,,412.55,percent of total billed charges,37.27% of total billed charges,515.69,37.27,,412.55,percent of total billed charges,37.27% of total billed charges,515.69,37.27,,412.55,percent of total billed charges,37.27% 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,553.46,40,,442.77,percent of total billed charges,40% of total billed charges,515.69,1106.92,
MORPHINE 10MG AMP,6065130,CDM,636,RC,J2270,HCPCS,Outpatient,,,13.1,10.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.48,80,,8.38,percent of total billed charges,80% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% 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,5.24,40,,4.19,percent of total billed charges,40% of total billed charges,4.88,10.48,
ATROPINE 1% OP SOLN,6400014,CDM,250,RC,,,Outpatient,,,348.2,278.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,278.56,80,,222.85,percent of total billed charges,80% of total billed charges,129.77,37.27,,103.82,percent of total billed charges,37.27% of total billed charges,129.77,37.27,,103.82,percent of total billed charges,37.27% of total billed charges,129.77,37.27,,103.82,percent of total billed charges,37.27% 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,139.28,40,,111.42,percent of total billed charges,40% of total billed charges,129.77,278.56,
AMIKACIN 4GM CREAM,6400014,CDM,250,RC,,,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% 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,28,40,,22.4,percent of total billed charges,40% of total billed charges,26.09,56,
CHANTIX 1MG TAB,6400014,CDM,250,RC,,,Outpatient,,,25.15,20.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.12,80,,16.1,percent of total billed charges,80% of total billed charges,9.37,37.27,,7.5,percent of total billed charges,37.27% of total billed charges,9.37,37.27,,7.5,percent of total billed charges,37.27% of total billed charges,9.37,37.27,,7.5,percent of total billed charges,37.27% 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,10.06,40,,8.05,percent of total billed charges,40% of total billed charges,9.37,20.12,
SYMBICORT 160-4.5,6400014,CDM,250,RC,,,Outpatient,,,1412.75,1130.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1130.2,80,,904.16,percent of total billed charges,80% of total billed charges,526.53,37.27,,421.22,percent of total billed charges,37.27% of total billed charges,526.53,37.27,,421.22,percent of total billed charges,37.27% of total billed charges,526.53,37.27,,421.22,percent of total billed charges,37.27% 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,565.1,40,,452.08,percent of total billed charges,40% of total billed charges,526.53,1130.2,
FENTANYL 100MCG/HR,6065130,CDM,636,RC,J3010,HCPCS,Outpatient,,,176.1,140.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.88,80,,112.7,percent of total billed charges,80% of total billed charges,65.63,37.27,,52.5,percent of total billed charges,37.27% of total billed charges,65.63,37.27,,52.5,percent of total billed charges,37.27% of total billed charges,65.63,37.27,,52.5,percent of total billed charges,37.27% 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,70.44,40,,56.35,percent of total billed charges,40% of total billed charges,65.63,140.88,
D.H.E.45 AMP,6065130,CDM,636,RC,J1110,HCPCS,Outpatient,,,286.73,229.38,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.38,80,,183.5,percent of total billed charges,80% of total billed charges,106.86,37.27,,85.49,percent of total billed charges,37.27% of total billed charges,106.86,37.27,,85.49,percent of total billed charges,37.27% of total billed charges,106.86,37.27,,85.49,percent of total billed charges,37.27% 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,114.69,40,,91.75,percent of total billed charges,40% of total billed charges,106.86,229.38,
PULMICORT 90MCG INH,6400014,CDM,250,RC,,,Outpatient,,,398,318.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% 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,159.2,40,,127.36,percent of total billed charges,40% of total billed charges,148.33,318.4,
ENDO OR FIRST PROC,8602000,CDM,750,RC,SURG,HCPCS,Outpatient,,,3373,2698.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2698.4,80,,2158.72,percent of total billed charges,80% of total billed charges,1257.12,37.27,,1005.7,percent of total billed charges,37.27% of total billed charges,1257.12,37.27,,1005.7,percent of total billed charges,37.27% of total billed charges,1257.12,37.27,,1005.7,percent of total billed charges,37.27% 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,1349.2,40,,1079.36,percent of total billed charges,40% of total billed charges,1257.12,2698.4,
PACING KIT BALECTROD,5645742,CDM,270,RC,,,Outpatient,,,356,284.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,284.8,80,,227.84,percent of total billed charges,80% of total billed charges,132.68,37.27,,106.14,percent of total billed charges,37.27% of total billed charges,132.68,37.27,,106.14,percent of total billed charges,37.27% of total billed charges,132.68,37.27,,106.14,percent of total billed charges,37.27% 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,142.4,40,,113.92,percent of total billed charges,40% of total billed charges,132.68,284.8,
ENDO RCVRY RM PER 30,8602010,CDM,710,RC,,,Outpatient,,,105,84.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% 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,42,40,,33.6,percent of total billed charges,40% of total billed charges,39.13,84,
KETOPROFEN 75MG,6400014,CDM,250,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
HUMIRA 20MG INJ,6065130,CDM,636,RC,J0135,HCPCS,Outpatient,,,2313.2,1850.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1850.56,80,,1480.45,percent of total billed charges,80% of total billed charges,862.13,37.27,,689.7,percent of total billed charges,37.27% of total billed charges,862.13,37.27,,689.7,percent of total billed charges,37.27% of total billed charges,862.13,37.27,,689.7,percent of total billed charges,37.27% of total billed charges,1834.49,100,,,fee schedule,100% of APC rate,1834.49,100,,,fee schedule,100% of APC rate,1834.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1834.49,100,,,fee schedule,100% of APC rate,1834.49,100,,,fee schedule,100% of APC rate,1834.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,925.28,40,,740.22,percent of total billed charges,40% of total billed charges,862.13,1850.56,
REQUIP 3MG,6400014,CDM,250,RC,,,Outpatient,,,10.9,8.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.72,80,,6.98,percent of total billed charges,80% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% of total billed charges,4.06,37.27,,3.25,percent of total billed charges,37.27% 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,4.36,40,,3.49,percent of total billed charges,40% of total billed charges,4.06,8.72,
ZICAM NASAL GEL,6400014,CDM,250,RC,,,Outpatient,,,33.9,27.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.12,80,,21.7,percent of total billed charges,80% of total billed charges,12.63,37.27,,10.1,percent of total billed charges,37.27% of total billed charges,12.63,37.27,,10.1,percent of total billed charges,37.27% of total billed charges,12.63,37.27,,10.1,percent of total billed charges,37.27% 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,13.56,40,,10.85,percent of total billed charges,40% of total billed charges,12.63,27.12,
EXTENDRYL DM TABLET,6400014,CDM,250,RC,,,Outpatient,,,3.8,3.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.04,80,,2.43,percent of total billed charges,80% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% 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,1.52,40,,1.22,percent of total billed charges,40% of total billed charges,1.42,3.04,
BROVANA 15MCG/2ML,5880901,CDM,637,RC,,,Outpatient,,,80.35,64.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.28,80,,51.42,percent of total billed charges,80% of total billed charges,29.95,37.27,,23.96,percent of total billed charges,37.27% of total billed charges,29.95,37.27,,23.96,percent of total billed charges,37.27% of total billed charges,29.95,37.27,,23.96,percent of total billed charges,37.27% 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,32.14,40,,25.71,percent of total billed charges,40% of total billed charges,29.95,64.28,
PULMICORT RESP 0.05,6400014,CDM,250,RC,J7626,HCPCS,Outpatient,,,37.95,30.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.36,80,,24.29,percent of total billed charges,80% of total billed charges,14.14,37.27,,11.31,percent of total billed charges,37.27% of total billed charges,14.14,37.27,,11.31,percent of total billed charges,37.27% of total billed charges,14.14,37.27,,11.31,percent of total billed charges,37.27% 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,15.18,40,,12.14,percent of total billed charges,40% of total billed charges,14.14,30.36,
BETAMETH.OINT.0.05%,6400014,CDM,250,RC,,,Outpatient,,,0.07,0.06,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.06,80,,0.05,percent of total billed charges,80% of total billed charges,0.03,37.27,,0.02,percent of total billed charges,37.27% of total billed charges,0.03,37.27,,0.02,percent of total billed charges,37.27% of total billed charges,0.03,37.27,,0.02,percent of total billed charges,37.27% 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,0.03,40,,0.02,percent of total billed charges,40% of total billed charges,0.03,0.06,
BRIMONIDINE 0.2% OPT,6400014,CDM,250,RC,,,Outpatient,,,274.15,219.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,219.32,80,,175.46,percent of total billed charges,80% of total billed charges,102.18,37.27,,81.74,percent of total billed charges,37.27% of total billed charges,102.18,37.27,,81.74,percent of total billed charges,37.27% of total billed charges,102.18,37.27,,81.74,percent of total billed charges,37.27% 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,109.66,40,,87.73,percent of total billed charges,40% of total billed charges,102.18,219.32,
VOLTAREN 0.1% OPHTH,6400014,CDM,250,RC,,,Outpatient,,,165.99,132.79,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.79,80,,106.23,percent of total billed charges,80% of total billed charges,61.86,37.27,,49.49,percent of total billed charges,37.27% of total billed charges,61.86,37.27,,49.49,percent of total billed charges,37.27% of total billed charges,61.86,37.27,,49.49,percent of total billed charges,37.27% 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,66.4,40,,53.12,percent of total billed charges,40% of total billed charges,61.86,132.79,
BRIMONIDINE 0.2% 5ML,6400014,CDM,250,RC,,,Outpatient,,,111.35,89.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.08,80,,71.26,percent of total billed charges,80% of total billed charges,41.5,37.27,,33.2,percent of total billed charges,37.27% of total billed charges,41.5,37.27,,33.2,percent of total billed charges,37.27% of total billed charges,41.5,37.27,,33.2,percent of total billed charges,37.27% 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,44.54,40,,35.63,percent of total billed charges,40% of total billed charges,41.5,89.08,
PSEUDOEPHEDRINE 120M,6400014,CDM,250,RC,,,Outpatient,,,5.45,4.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.36,80,,3.49,percent of total billed charges,80% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% of total billed charges,2.03,37.27,,1.62,percent of total billed charges,37.27% 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,2.18,40,,1.74,percent of total billed charges,40% of total billed charges,2.03,4.36,
TOPROL XL 25MG,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
RISPERDAL 25MG INJ,6400014,CDM,250,RC,,,Outpatient,,,2219.8,1775.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1775.84,80,,1420.67,percent of total billed charges,80% of total billed charges,827.32,37.27,,661.86,percent of total billed charges,37.27% of total billed charges,827.32,37.27,,661.86,percent of total billed charges,37.27% of total billed charges,827.32,37.27,,661.86,percent of total billed charges,37.27% 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,887.92,40,,710.34,percent of total billed charges,40% of total billed charges,827.32,1775.84,
NEUPRO 4MG/24H PATCH,6400014,CDM,250,RC,,,Outpatient,,,0.01,0.01,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,80,,0.01,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,0.01,0.01,
REPLIVA,6400014,CDM,250,RC,,,Outpatient,,,100.8,80.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.64,80,,64.51,percent of total billed charges,80% of total billed charges,37.57,37.27,,30.06,percent of total billed charges,37.27% of total billed charges,37.57,37.27,,30.06,percent of total billed charges,37.27% of total billed charges,37.57,37.27,,30.06,percent of total billed charges,37.27% 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,40.32,40,,32.26,percent of total billed charges,40% of total billed charges,37.57,80.64,
PALGIC 4MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.15,2.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,80,,2.02,percent of total billed charges,80% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% 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,1.26,40,,1.01,percent of total billed charges,40% of total billed charges,1.17,2.52,
EXELON 4.6MG/DAY PAT,6400014,CDM,250,RC,,,Outpatient,,,80.95,64.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.76,80,,51.81,percent of total billed charges,80% of total billed charges,30.17,37.27,,24.14,percent of total billed charges,37.27% of total billed charges,30.17,37.27,,24.14,percent of total billed charges,37.27% of total billed charges,30.17,37.27,,24.14,percent of total billed charges,37.27% 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,32.38,40,,25.9,percent of total billed charges,40% of total billed charges,30.17,64.76,
BYSTOLIC 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,24.9,19.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.92,80,,15.94,percent of total billed charges,80% of total billed charges,9.28,37.27,,7.42,percent of total billed charges,37.27% of total billed charges,9.28,37.27,,7.42,percent of total billed charges,37.27% of total billed charges,9.28,37.27,,7.42,percent of total billed charges,37.27% 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,9.96,40,,7.97,percent of total billed charges,40% of total billed charges,9.28,19.92,
KEPPRA SOLN 100MG/ML,6065130,CDM,636,RC,J1953,HCPCS,Outpatient,,,65.65,52.52,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.52,80,,42.02,percent of total billed charges,80% of total billed charges,24.47,37.27,,19.58,percent of total billed charges,37.27% of total billed charges,24.47,37.27,,19.58,percent of total billed charges,37.27% of total billed charges,24.47,37.27,,19.58,percent of total billed charges,37.27% 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,26.26,40,,21.01,percent of total billed charges,40% of total billed charges,24.47,52.52,
METHYLIN 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.65,2.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.92,80,,2.34,percent of total billed charges,80% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% 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,1.46,40,,1.17,percent of total billed charges,40% of total billed charges,1.36,2.92,
SYMLIN 0.6MG/ML INJ,6400014,CDM,250,RC,,,Outpatient,,,398.05,318.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.44,80,,254.75,percent of total billed charges,80% of total billed charges,148.35,37.27,,118.68,percent of total billed charges,37.27% of total billed charges,148.35,37.27,,118.68,percent of total billed charges,37.27% of total billed charges,148.35,37.27,,118.68,percent of total billed charges,37.27% 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,159.22,40,,127.38,percent of total billed charges,40% of total billed charges,148.35,318.44,
CALMOSEPTINE OINT.,6400014,CDM,250,RC,,,Outpatient,,,8.15,6.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.52,80,,5.22,percent of total billed charges,80% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% of total billed charges,3.04,37.27,,2.43,percent of total billed charges,37.27% 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,3.26,40,,2.61,percent of total billed charges,40% of total billed charges,3.04,6.52,
LIALDA 1.2GM TAB,6400014,CDM,250,RC,,,Outpatient,,,38.3,30.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.64,80,,24.51,percent of total billed charges,80% of total billed charges,14.27,37.27,,11.42,percent of total billed charges,37.27% of total billed charges,14.27,37.27,,11.42,percent of total billed charges,37.27% of total billed charges,14.27,37.27,,11.42,percent of total billed charges,37.27% 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,15.32,40,,12.26,percent of total billed charges,40% of total billed charges,14.27,30.64,
IMIPRAMINE 25MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.95,2.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,80,,1.89,percent of total billed charges,80% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% 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,1.18,40,,0.94,percent of total billed charges,40% of total billed charges,1.1,2.36,
BETAMETH.DIPR.CR.05%,6400014,CDM,250,RC,,,Outpatient,,,25.74,20.59,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.59,80,,16.47,percent of total billed charges,80% of total billed charges,9.59,37.27,,7.67,percent of total billed charges,37.27% of total billed charges,9.59,37.27,,7.67,percent of total billed charges,37.27% of total billed charges,9.59,37.27,,7.67,percent of total billed charges,37.27% 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,10.3,40,,8.24,percent of total billed charges,40% of total billed charges,9.59,20.59,
GLYCOPYRROLATE 1MG,6400014,CDM,250,RC,,,Outpatient,,,4.45,3.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.56,80,,2.85,percent of total billed charges,80% of total billed charges,1.66,37.27,,1.33,percent of total billed charges,37.27% of total billed charges,1.66,37.27,,1.33,percent of total billed charges,37.27% of total billed charges,1.66,37.27,,1.33,percent of total billed charges,37.27% 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,1.78,40,,1.42,percent of total billed charges,40% of total billed charges,1.66,3.56,
CARBETAPLEX LIQUID,6400014,CDM,250,RC,,,Outpatient,,,10.55,8.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.44,80,,6.75,percent of total billed charges,80% of total billed charges,3.93,37.27,,3.14,percent of total billed charges,37.27% of total billed charges,3.93,37.27,,3.14,percent of total billed charges,37.27% of total billed charges,3.93,37.27,,3.14,percent of total billed charges,37.27% 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,4.22,40,,3.38,percent of total billed charges,40% of total billed charges,3.93,8.44,
ALTABAX OINT 10GM,6400014,CDM,250,RC,,,Outpatient,,,299.9,239.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,239.92,80,,191.94,percent of total billed charges,80% of total billed charges,111.77,37.27,,89.42,percent of total billed charges,37.27% of total billed charges,111.77,37.27,,89.42,percent of total billed charges,37.27% of total billed charges,111.77,37.27,,89.42,percent of total billed charges,37.27% 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,119.96,40,,95.97,percent of total billed charges,40% of total billed charges,111.77,239.92,
SLEEP AID TAB 25MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CIPROFLOXACIN 400MG,6065130,CDM,636,RC,J0744,HCPCS,Outpatient,,,45.35,36.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.28,80,,29.02,percent of total billed charges,80% of total billed charges,16.9,37.27,,13.52,percent of total billed charges,37.27% of total billed charges,16.9,37.27,,13.52,percent of total billed charges,37.27% of total billed charges,16.9,37.27,,13.52,percent of total billed charges,37.27% 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,18.14,40,,14.51,percent of total billed charges,40% of total billed charges,16.9,36.28,
AMITIZA 8MCG CAP,6400014,CDM,250,RC,,,Outpatient,,,43.15,34.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.52,80,,27.62,percent of total billed charges,80% of total billed charges,16.08,37.27,,12.86,percent of total billed charges,37.27% of total billed charges,16.08,37.27,,12.86,percent of total billed charges,37.27% of total billed charges,16.08,37.27,,12.86,percent of total billed charges,37.27% 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,17.26,40,,13.81,percent of total billed charges,40% of total billed charges,16.08,34.52,
LANTISEPTIC,6400014,CDM,250,RC,,,Outpatient,,,3.81,3.05,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.05,80,,2.44,percent of total billed charges,80% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% of total billed charges,1.42,37.27,,1.14,percent of total billed charges,37.27% 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,1.52,40,,1.22,percent of total billed charges,40% of total billed charges,1.42,3.05,
NAROPIN 0.2% 100ML,6065130,CDM,636,RC,J2795,HCPCS,Outpatient,,,158.05,126.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.44,80,,101.15,percent of total billed charges,80% of total billed charges,58.91,37.27,,47.13,percent of total billed charges,37.27% of total billed charges,58.91,37.27,,47.13,percent of total billed charges,37.27% of total billed charges,58.91,37.27,,47.13,percent of total billed charges,37.27% 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,63.22,40,,50.58,percent of total billed charges,40% of total billed charges,58.91,126.44,
RIFAMPIN 150MG CAP,6400014,CDM,250,RC,,,Outpatient,,,6.15,4.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.92,80,,3.94,percent of total billed charges,80% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% of total billed charges,2.29,37.27,,1.83,percent of total billed charges,37.27% 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,2.46,40,,1.97,percent of total billed charges,40% of total billed charges,2.29,4.92,
FLECTOR PATCH 1.3%,6400014,CDM,250,RC,,,Outpatient,,,50.85,40.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.68,80,,32.54,percent of total billed charges,80% of total billed charges,18.95,37.27,,15.16,percent of total billed charges,37.27% of total billed charges,18.95,37.27,,15.16,percent of total billed charges,37.27% of total billed charges,18.95,37.27,,15.16,percent of total billed charges,37.27% 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,20.34,40,,16.27,percent of total billed charges,40% of total billed charges,18.95,40.68,
MERCUROCLEAR SOLN.,6400014,CDM,250,RC,,,Outpatient,,,0.07,0.06,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.06,80,,0.05,percent of total billed charges,80% of total billed charges,0.03,37.27,,0.02,percent of total billed charges,37.27% of total billed charges,0.03,37.27,,0.02,percent of total billed charges,37.27% of total billed charges,0.03,37.27,,0.02,percent of total billed charges,37.27% 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,0.03,40,,0.02,percent of total billed charges,40% of total billed charges,0.03,0.06,
EXELON 9.5MG PATCH,6400014,CDM,250,RC,,,Outpatient,,,85.35,68.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.28,80,,54.62,percent of total billed charges,80% of total billed charges,31.81,37.27,,25.45,percent of total billed charges,37.27% of total billed charges,31.81,37.27,,25.45,percent of total billed charges,37.27% of total billed charges,31.81,37.27,,25.45,percent of total billed charges,37.27% 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,34.14,40,,27.31,percent of total billed charges,40% of total billed charges,31.81,68.28,
REVATIO 20MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,76.6,61.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.28,80,,49.02,percent of total billed charges,80% of total billed charges,28.55,37.27,,22.84,percent of total billed charges,37.27% of total billed charges,28.55,37.27,,22.84,percent of total billed charges,37.27% of total billed charges,28.55,37.27,,22.84,percent of total billed charges,37.27% 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,30.64,40,,24.51,percent of total billed charges,40% of total billed charges,28.55,61.28,
RELISTOR 12MG/0.6ML,6400014,CDM,250,RC,,,Outpatient,,,965.05,772.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,772.04,80,,617.63,percent of total billed charges,80% of total billed charges,359.67,37.27,,287.74,percent of total billed charges,37.27% of total billed charges,359.67,37.27,,287.74,percent of total billed charges,37.27% of total billed charges,359.67,37.27,,287.74,percent of total billed charges,37.27% 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,386.02,40,,308.82,percent of total billed charges,40% of total billed charges,359.67,772.04,
SOD CHLORIDE 10MLSYR,5880901,CDM,637,RC,A4216,HCPCS,Outpatient,,,15.8,12.64,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.64,80,,10.11,percent of total billed charges,80% of total billed charges,5.89,37.27,,4.71,percent of total billed charges,37.27% of total billed charges,5.89,37.27,,4.71,percent of total billed charges,37.27% of total billed charges,5.89,37.27,,4.71,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.61,100,,,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,6.32,40,,5.06,percent of total billed charges,40% of total billed charges,0.61,12.64,
FLOVENT DISKUS 50MCG,6400014,CDM,250,RC,,,Outpatient,,,607.4,485.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,485.92,80,,388.74,percent of total billed charges,80% of total billed charges,226.38,37.27,,181.1,percent of total billed charges,37.27% of total billed charges,226.38,37.27,,181.1,percent of total billed charges,37.27% of total billed charges,226.38,37.27,,181.1,percent of total billed charges,37.27% 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,242.96,40,,194.37,percent of total billed charges,40% of total billed charges,226.38,485.92,
FEMARA 2.5MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,68.65,54.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.92,80,,43.94,percent of total billed charges,80% of total billed charges,25.59,37.27,,20.47,percent of total billed charges,37.27% of total billed charges,25.59,37.27,,20.47,percent of total billed charges,37.27% of total billed charges,25.59,37.27,,20.47,percent of total billed charges,37.27% 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,27.46,40,,21.97,percent of total billed charges,40% of total billed charges,25.59,54.92,
RABAVERT RABIES VACC,6065130,CDM,636,RC,90675,HCPCS,Outpatient,,,1182.2,945.76,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,945.76,80,,756.61,percent of total billed charges,80% of total billed charges,440.61,37.27,,352.49,percent of total billed charges,37.27% of total billed charges,440.61,37.27,,352.49,percent of total billed charges,37.27% of total billed charges,440.61,37.27,,352.49,percent of total billed charges,37.27% of total billed charges,350.14,100,,,fee schedule,100% of APC rate,350.14,100,,,fee schedule,100% of APC rate,350.14,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,350.14,100,,,fee schedule,100% of APC rate,350.14,100,,,fee schedule,100% of APC rate,350.14,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472.88,40,,378.3,percent of total billed charges,40% of total billed charges,350.14,945.76,
AMILORIDE 5MG,6400014,CDM,250,RC,,,Outpatient,,,4.35,3.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.48,80,,2.78,percent of total billed charges,80% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% 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,1.74,40,,1.39,percent of total billed charges,40% of total billed charges,1.62,3.48,
GEODON 60MG,6400014,CDM,250,RC,,,Outpatient,,,24.35,19.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.48,80,,15.58,percent of total billed charges,80% of total billed charges,9.08,37.27,,7.26,percent of total billed charges,37.27% of total billed charges,9.08,37.27,,7.26,percent of total billed charges,37.27% of total billed charges,9.08,37.27,,7.26,percent of total billed charges,37.27% 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,9.74,40,,7.79,percent of total billed charges,40% of total billed charges,9.08,19.48,
PRISTIQ 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,59.7,47.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.76,80,,38.21,percent of total billed charges,80% of total billed charges,22.25,37.27,,17.8,percent of total billed charges,37.27% of total billed charges,22.25,37.27,,17.8,percent of total billed charges,37.27% of total billed charges,22.25,37.27,,17.8,percent of total billed charges,37.27% 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,23.88,40,,19.1,percent of total billed charges,40% of total billed charges,22.25,47.76,
HISTEX SR TABLET,6400014,CDM,250,RC,,,Outpatient,,,3.15,2.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.52,80,,2.02,percent of total billed charges,80% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% of total billed charges,1.17,37.27,,0.94,percent of total billed charges,37.27% 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,1.26,40,,1.01,percent of total billed charges,40% of total billed charges,1.17,2.52,
PATADAY OPHTH,6400014,CDM,250,RC,,,Outpatient,,,651.75,521.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,521.4,80,,417.12,percent of total billed charges,80% of total billed charges,242.91,37.27,,194.33,percent of total billed charges,37.27% of total billed charges,242.91,37.27,,194.33,percent of total billed charges,37.27% of total billed charges,242.91,37.27,,194.33,percent of total billed charges,37.27% 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,260.7,40,,208.56,percent of total billed charges,40% of total billed charges,242.91,521.4,
EVOXAC 30MG CAP,6400014,CDM,250,RC,,,Outpatient,,,18.65,14.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.92,80,,11.94,percent of total billed charges,80% of total billed charges,6.95,37.27,,5.56,percent of total billed charges,37.27% of total billed charges,6.95,37.27,,5.56,percent of total billed charges,37.27% of total billed charges,6.95,37.27,,5.56,percent of total billed charges,37.27% 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,7.46,40,,5.97,percent of total billed charges,40% of total billed charges,6.95,14.92,
CLARITIN SYRUP (OZ),6400014,CDM,250,RC,,,Outpatient,,,10.1,8.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.08,80,,6.46,percent of total billed charges,80% of total billed charges,3.76,37.27,,3.01,percent of total billed charges,37.27% of total billed charges,3.76,37.27,,3.01,percent of total billed charges,37.27% of total billed charges,3.76,37.27,,3.01,percent of total billed charges,37.27% 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,4.04,40,,3.23,percent of total billed charges,40% of total billed charges,3.76,8.08,
VESICARE 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,33.15,26.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.52,80,,21.22,percent of total billed charges,80% of total billed charges,12.36,37.27,,9.89,percent of total billed charges,37.27% of total billed charges,12.36,37.27,,9.89,percent of total billed charges,37.27% of total billed charges,12.36,37.27,,9.89,percent of total billed charges,37.27% 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,13.26,40,,10.61,percent of total billed charges,40% of total billed charges,12.36,26.52,
ETHYL CHLORIDE SPRAY,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
METHENAMINE HIPP 1GM,6400014,CDM,250,RC,,,Outpatient,,,6.05,4.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,80,,3.87,percent of total billed charges,80% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% 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,2.42,40,,1.94,percent of total billed charges,40% of total billed charges,2.25,4.84,
ZEGERID 20MG/1100MG,6400014,CDM,250,RC,,,Outpatient,,,57.45,45.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.96,80,,36.77,percent of total billed charges,80% of total billed charges,21.41,37.27,,17.13,percent of total billed charges,37.27% of total billed charges,21.41,37.27,,17.13,percent of total billed charges,37.27% of total billed charges,21.41,37.27,,17.13,percent of total billed charges,37.27% 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,22.98,40,,18.38,percent of total billed charges,40% of total billed charges,21.41,45.96,
ZEGERID 40MG/1100MG,6400014,CDM,250,RC,,,Outpatient,,,57.45,45.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.96,80,,36.77,percent of total billed charges,80% of total billed charges,21.41,37.27,,17.13,percent of total billed charges,37.27% of total billed charges,21.41,37.27,,17.13,percent of total billed charges,37.27% of total billed charges,21.41,37.27,,17.13,percent of total billed charges,37.27% 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,22.98,40,,18.38,percent of total billed charges,40% of total billed charges,21.41,45.96,
OMEPRAZOLE 20MG CAP,6400014,CDM,250,RC,,,Outpatient,,,14.15,11.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.32,80,,9.06,percent of total billed charges,80% of total billed charges,5.27,37.27,,4.22,percent of total billed charges,37.27% of total billed charges,5.27,37.27,,4.22,percent of total billed charges,37.27% of total billed charges,5.27,37.27,,4.22,percent of total billed charges,37.27% 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,5.66,40,,4.53,percent of total billed charges,40% of total billed charges,5.27,11.32,
CHLORA PREP,5801832,CDM,272,RC,,,Outpatient,,,30,24.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% 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,12,40,,9.6,percent of total billed charges,40% of total billed charges,11.18,24,
MESH VENTRALEX SM,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,1214,971.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,971.2,80,,776.96,percent of total billed charges,80% of total billed charges,452.46,37.27,,361.97,percent of total billed charges,37.27% of total billed charges,452.46,37.27,,361.97,percent of total billed charges,37.27% of total billed charges,452.46,37.27,,361.97,percent of total billed charges,37.27% 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,485.6,40,,388.48,percent of total billed charges,40% of total billed charges,452.46,971.2,
MESH VENTRALEX MED,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,1418,1134.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1134.4,80,,907.52,percent of total billed charges,80% of total billed charges,528.49,37.27,,422.79,percent of total billed charges,37.27% of total billed charges,528.49,37.27,,422.79,percent of total billed charges,37.27% of total billed charges,528.49,37.27,,422.79,percent of total billed charges,37.27% 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,567.2,40,,453.76,percent of total billed charges,40% of total billed charges,528.49,1134.4,
MESH VENTRALEX LG,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,1622,1297.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1297.6,80,,1038.08,percent of total billed charges,80% of total billed charges,604.52,37.27,,483.62,percent of total billed charges,37.27% of total billed charges,604.52,37.27,,483.62,percent of total billed charges,37.27% of total billed charges,604.52,37.27,,483.62,percent of total billed charges,37.27% 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,648.8,40,,519.04,percent of total billed charges,40% of total billed charges,604.52,1297.6,
XYZAL 5MG,6400014,CDM,250,RC,,,Outpatient,,,14.9,11.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.92,80,,9.54,percent of total billed charges,80% of total billed charges,5.55,37.27,,4.44,percent of total billed charges,37.27% of total billed charges,5.55,37.27,,4.44,percent of total billed charges,37.27% of total billed charges,5.55,37.27,,4.44,percent of total billed charges,37.27% 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,5.96,40,,4.77,percent of total billed charges,40% of total billed charges,5.55,11.92,
ARICEPT 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,34.85,27.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.88,80,,22.3,percent of total billed charges,80% of total billed charges,12.99,37.27,,10.39,percent of total billed charges,37.27% of total billed charges,12.99,37.27,,10.39,percent of total billed charges,37.27% of total billed charges,12.99,37.27,,10.39,percent of total billed charges,37.27% 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,13.94,40,,11.15,percent of total billed charges,40% of total billed charges,12.99,27.88,
VENTOLIN HFA INHALER,6400014,CDM,250,RC,,,Outpatient,,,122.9,98.32,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.32,80,,78.66,percent of total billed charges,80% of total billed charges,45.8,37.27,,36.64,percent of total billed charges,37.27% of total billed charges,45.8,37.27,,36.64,percent of total billed charges,37.27% of total billed charges,45.8,37.27,,36.64,percent of total billed charges,37.27% 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,49.16,40,,39.33,percent of total billed charges,40% of total billed charges,45.8,98.32,
AMERIGEL CARE LOTION,6400014,CDM,250,RC,,,Outpatient,,,74.8,59.84,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.84,80,,47.87,percent of total billed charges,80% of total billed charges,27.88,37.27,,22.3,percent of total billed charges,37.27% of total billed charges,27.88,37.27,,22.3,percent of total billed charges,37.27% of total billed charges,27.88,37.27,,22.3,percent of total billed charges,37.27% 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,29.92,40,,23.94,percent of total billed charges,40% of total billed charges,27.88,59.84,
AKTEN OPTH GEL 3.5%,6400014,CDM,250,RC,,,Outpatient,,,123.72,98.98,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.98,80,,79.18,percent of total billed charges,80% of total billed charges,46.11,37.27,,36.89,percent of total billed charges,37.27% of total billed charges,46.11,37.27,,36.89,percent of total billed charges,37.27% of total billed charges,46.11,37.27,,36.89,percent of total billed charges,37.27% 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,49.49,40,,39.59,percent of total billed charges,40% of total billed charges,46.11,98.98,
ESTRACE VAGINAL CRM,6400014,CDM,250,RC,,,Outpatient,,,1204,963.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,963.2,80,,770.56,percent of total billed charges,80% of total billed charges,448.73,37.27,,358.98,percent of total billed charges,37.27% of total billed charges,448.73,37.27,,358.98,percent of total billed charges,37.27% of total billed charges,448.73,37.27,,358.98,percent of total billed charges,37.27% 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,481.6,40,,385.28,percent of total billed charges,40% of total billed charges,448.73,963.2,
SANCTURA XR 60MG,6400014,CDM,250,RC,,,Outpatient,,,25.5,20.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.4,80,,16.32,percent of total billed charges,80% of total billed charges,9.5,37.27,,7.6,percent of total billed charges,37.27% of total billed charges,9.5,37.27,,7.6,percent of total billed charges,37.27% of total billed charges,9.5,37.27,,7.6,percent of total billed charges,37.27% 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,10.2,40,,8.16,percent of total billed charges,40% of total billed charges,9.5,20.4,
FLUTAMIDE 125MG CAP,6400014,CDM,250,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
DRESSING ALLEVYN 5X5,5801832,CDM,272,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
SULAR SR 17MG TAB,6400014,CDM,250,RC,,,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% 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,44,40,,35.2,percent of total billed charges,40% of total billed charges,41,88,
ABILIFY 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,80.7,64.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.56,80,,51.65,percent of total billed charges,80% of total billed charges,30.08,37.27,,24.06,percent of total billed charges,37.27% of total billed charges,30.08,37.27,,24.06,percent of total billed charges,37.27% of total billed charges,30.08,37.27,,24.06,percent of total billed charges,37.27% 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,32.28,40,,25.82,percent of total billed charges,40% of total billed charges,30.08,64.56,
MEDIHONEY CAL ALG,5645742,CDM,270,RC,,,Outpatient,,,100,80.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% 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,40,40,,32,percent of total billed charges,40% of total billed charges,37.27,80,
BIOPSY - PUNCH,5645742,CDM,270,RC,,,Outpatient,,,108,86.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% 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,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,40.25,86.4,
CORICIDIN HBP TAB,5880901,CDM,637,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
SULAR SR 8.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,54.1,43.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.28,80,,34.62,percent of total billed charges,80% of total billed charges,20.16,37.27,,16.13,percent of total billed charges,37.27% of total billed charges,20.16,37.27,,16.13,percent of total billed charges,37.27% of total billed charges,20.16,37.27,,16.13,percent of total billed charges,37.27% 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,21.64,40,,17.31,percent of total billed charges,40% of total billed charges,20.16,43.28,
FAZACLO 100MG,6400014,CDM,250,RC,,,Outpatient,,,52.25,41.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.8,80,,33.44,percent of total billed charges,80% of total billed charges,19.47,37.27,,15.58,percent of total billed charges,37.27% of total billed charges,19.47,37.27,,15.58,percent of total billed charges,37.27% of total billed charges,19.47,37.27,,15.58,percent of total billed charges,37.27% 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,20.9,40,,16.72,percent of total billed charges,40% of total billed charges,19.47,41.8,
TOPROL XL 25MG,6400014,CDM,250,RC,,,Outpatient,,,9.75,7.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.8,80,,6.24,percent of total billed charges,80% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% 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,3.9,40,,3.12,percent of total billed charges,40% of total billed charges,3.63,7.8,
CUBICIN500MG PER10MG,6065130,CDM,636,RC,J0878,HCPCS,Outpatient,,,3.65,2.92,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.92,80,,2.34,percent of total billed charges,80% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% 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,1.46,40,,1.17,percent of total billed charges,40% of total billed charges,1.36,2.92,
SENSIPAR 30MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,100,80.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% 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,40,40,,32,percent of total billed charges,40% of total billed charges,37.27,80,
SUSTANE OPTH DROPS,6400014,CDM,250,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
AMVISC PLUS SYRINGE,6400014,CDM,250,RC,,,Outpatient,,,532,425.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% 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,212.8,40,,170.24,percent of total billed charges,40% of total billed charges,198.28,425.6,
ATROVENT HFA INHALER,6400014,CDM,250,RC,,,Outpatient,,,1478.45,1182.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1182.76,80,,946.21,percent of total billed charges,80% of total billed charges,551.02,37.27,,440.82,percent of total billed charges,37.27% of total billed charges,551.02,37.27,,440.82,percent of total billed charges,37.27% of total billed charges,551.02,37.27,,440.82,percent of total billed charges,37.27% 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,591.38,40,,473.1,percent of total billed charges,40% of total billed charges,551.02,1182.76,
JUVEN NUTRITIONAL,5880901,CDM,637,RC,,,Outpatient,,,8.3,6.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.64,80,,5.31,percent of total billed charges,80% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% 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,3.32,40,,2.66,percent of total billed charges,40% of total billed charges,3.09,6.64,
HEPATITS B PED VACCI,6065130,CDM,636,RC,90744,HCPCS,Outpatient,,,190.15,152.12,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152.12,80,,121.7,percent of total billed charges,80% of total billed charges,70.87,37.27,,56.7,percent of total billed charges,37.27% of total billed charges,70.87,37.27,,56.7,percent of total billed charges,37.27% of total billed charges,70.87,37.27,,56.7,percent of total billed charges,37.27% 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,76.06,40,,60.85,percent of total billed charges,40% of total billed charges,70.87,152.12,
TOPAMAX 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,23.3,18.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.64,80,,14.91,percent of total billed charges,80% of total billed charges,8.68,37.27,,6.94,percent of total billed charges,37.27% of total billed charges,8.68,37.27,,6.94,percent of total billed charges,37.27% of total billed charges,8.68,37.27,,6.94,percent of total billed charges,37.27% 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,9.32,40,,7.46,percent of total billed charges,40% of total billed charges,8.68,18.64,
FOLAMIN,6400014,CDM,250,RC,,,Outpatient,,,3.1,2.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.48,80,,1.98,percent of total billed charges,80% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% 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,1.24,40,,0.99,percent of total billed charges,40% of total billed charges,1.16,2.48,
SINGULAIR 4MG PACKET,6400014,CDM,250,RC,,,Outpatient,,,19.45,15.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.56,80,,12.45,percent of total billed charges,80% of total billed charges,7.25,37.27,,5.8,percent of total billed charges,37.27% of total billed charges,7.25,37.27,,5.8,percent of total billed charges,37.27% of total billed charges,7.25,37.27,,5.8,percent of total billed charges,37.27% 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,7.78,40,,6.22,percent of total billed charges,40% of total billed charges,7.25,15.56,
THORACENTESIS,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,1038,830.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,830.4,80,,664.32,percent of total billed charges,80% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% 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,415.2,40,,332.16,percent of total billed charges,40% of total billed charges,386.86,830.4,
CHEST TUBE PLCMNT,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,1038,830.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,830.4,80,,664.32,percent of total billed charges,80% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% 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,415.2,40,,332.16,percent of total billed charges,40% of total billed charges,386.86,830.4,
MEDSURG BLOOD TRANSF,5811120,CDM,391,RC,36430,HCPCS,Outpatient,,,1034,827.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,827.2,80,,661.76,percent of total billed charges,80% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,54.09,145,,,fee schedule,145% of CMS fee schedule,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413.6,40,,330.88,percent of total billed charges,40% of total billed charges,54.09,827.2,
BLOOD COLLECT FM POR,8400010,CDM,760,RC,36591,HCPCS,Outpatient,,,146,116.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,35.22,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,35.22,116.8,
BLOOD COLLECT FM PIC,8400010,CDM,760,RC,36592,HCPCS,Outpatient,,,175,140.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140,80,,112,percent of total billed charges,80% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,38.18,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70,40,,56,percent of total billed charges,40% of total billed charges,38.18,140,
PARACENTESIS,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,1038,830.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,830.4,80,,664.32,percent of total billed charges,80% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% 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,415.2,40,,332.16,percent of total billed charges,40% of total billed charges,386.86,830.4,
BLADDER SCAN,8400010,CDM,760,RC,51798,HCPCS,Outpatient,,,140,112.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112,80,,89.6,percent of total billed charges,80% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,14.5,145,,,fee schedule,145% of CMS fee schedule,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,40,,44.8,percent of total billed charges,40% of total billed charges,14.5,112,
PNEUM ADMINISTRATION,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,74,59.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,27.36,59.2,
IV HYDR INITIAL,5811182,CDM,260,RC,96360,HCPCS,Outpatient,,,222,177.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,42.15,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,40,,71.04,percent of total billed charges,40% of total billed charges,42.15,177.6,
IV HYDR EA ADDL,5811182,CDM,260,RC,96361,HCPCS,Outpatient,,,77,61.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,16.3,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,16.3,61.6,
IV INFUSION SEQ 1HR,5811182,CDM,260,RC,96367,HCPCS,Outpatient,,,134,107.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,37.19,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,40,,42.88,percent of total billed charges,40% of total billed charges,37.19,107.2,
IV INFUSION CONCUR,5811182,CDM,260,RC,96368,HCPCS,Outpatient,,,146,116.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.09,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,26.09,116.8,
INJECTION SUBC OR IM,5811182,CDM,260,RC,96372,HCPCS,Outpatient,,,77,61.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,19.31,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,19.31,61.6,
IV PUSH INITIAL,5811182,CDM,260,RC,96374,HCPCS,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,47.84,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198,40,,158.4,percent of total billed charges,40% of total billed charges,47.84,396,
IV PUSH EA ADDL NEW,5811182,CDM,260,RC,96375,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,20.17,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,40,,35.2,percent of total billed charges,40% of total billed charges,20.17,88,
IV PUSH EA ADDL SAME,5811182,CDM,260,RC,96376,HCPCS,Outpatient,,,108,86.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% 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,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,40.25,86.4,
DLVRY MULT NO EPISIO,8411001,CDM,722,RC,,,Outpatient,,,7389,5911.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5911.2,80,,4728.96,percent of total billed charges,80% of total billed charges,2753.88,37.27,,2203.1,percent of total billed charges,37.27% of total billed charges,2753.88,37.27,,2203.1,percent of total billed charges,37.27% of total billed charges,2753.88,37.27,,2203.1,percent of total billed charges,37.27% 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,2955.6,40,,2364.48,percent of total billed charges,40% of total billed charges,2753.88,5911.2,
THORACENTESIS,6000160,CDM,361,RC,SURG,HCPCS,Outpatient,,,1038,830.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,830.4,80,,664.32,percent of total billed charges,80% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% 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,415.2,40,,332.16,percent of total billed charges,40% of total billed charges,386.86,830.4,
CHEST TUBE PLCMNT,6000160,CDM,361,RC,SURG,HCPCS,Outpatient,,,1038,830.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,830.4,80,,664.32,percent of total billed charges,80% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% 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,415.2,40,,332.16,percent of total billed charges,40% of total billed charges,386.86,830.4,
ICU BLOOD TRANSFUS,5811120,CDM,391,RC,36430,HCPCS,Outpatient,,,1034,827.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,827.2,80,,661.76,percent of total billed charges,80% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,54.09,145,,,fee schedule,145% of CMS fee schedule,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413.6,40,,330.88,percent of total billed charges,40% of total billed charges,54.09,827.2,
INSERT CV CATH >5YR,6000160,CDM,361,RC,36556,HCPCS,Outpatient,,,4700,3760.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3760,80,,3008,percent of total billed charges,80% of total billed charges,1751.69,37.27,,1401.35,percent of total billed charges,37.27% of total billed charges,1751.69,37.27,,1401.35,percent of total billed charges,37.27% of total billed charges,1751.69,37.27,,1401.35,percent of total billed charges,37.27% of total billed charges,2628.1,100,,,fee schedule,100% of APC rate,2628.1,100,,,fee schedule,100% of APC rate,2628.1,100,,,fee schedule,100% of APC rate,118.73,145,,,fee schedule,145% of CMS fee schedule,2628.1,100,,,fee schedule,100% of APC rate,2628.1,100,,,fee schedule,100% of APC rate,2628.1,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1880,40,,1504,percent of total billed charges,40% of total billed charges,118.73,3760,
PORT BLOOD SPEC,7012032,CDM,300,RC,36591,HCPCS,Outpatient,,,146,116.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,35.22,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,35.22,116.8,
CATH BLOOD SPEC,7012032,CDM,300,RC,36592,HCPCS,Outpatient,,,118,94.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,38.18,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,40,,37.76,percent of total billed charges,40% of total billed charges,38.18,105.32,
PARACENTESIS,6000160,CDM,361,RC,SURG,HCPCS,Outpatient,,,1038,830.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,830.4,80,,664.32,percent of total billed charges,80% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% 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,415.2,40,,332.16,percent of total billed charges,40% of total billed charges,386.86,830.4,
INJECTION SUBC OR IM,5811182,CDM,260,RC,96372,HCPCS,Outpatient,,,77,61.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,19.31,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,19.31,61.6,
IV PUSH INITIAL,5811182,CDM,260,RC,96374,HCPCS,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,47.84,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198,40,,158.4,percent of total billed charges,40% of total billed charges,47.84,396,
IV PUSH EA ADDL NEW,5811182,CDM,260,RC,96375,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,20.17,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,40,,35.2,percent of total billed charges,40% of total billed charges,20.17,88,
IV PUSH EA ADDL SAME,5811182,CDM,260,RC,96376,HCPCS,Outpatient,,,108,86.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% 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,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,40.25,86.4,
THORACENTESIS,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,1038,830.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,830.4,80,,664.32,percent of total billed charges,80% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% 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,415.2,40,,332.16,percent of total billed charges,40% of total billed charges,386.86,830.4,
CHEST TUBE PLCMNT,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,1038,830.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,830.4,80,,664.32,percent of total billed charges,80% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% 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,415.2,40,,332.16,percent of total billed charges,40% of total billed charges,386.86,830.4,
PARACENTESIS,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,1038,830.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,830.4,80,,664.32,percent of total billed charges,80% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% 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,415.2,40,,332.16,percent of total billed charges,40% of total billed charges,386.86,830.4,
INJECTION SUBC OR IM,5811182,CDM,260,RC,96372,HCPCS,Outpatient,,,77,61.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,19.31,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,19.31,61.6,
IV PUSH INITIAL,5811182,CDM,260,RC,96374,HCPCS,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,47.84,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198,40,,158.4,percent of total billed charges,40% of total billed charges,47.84,396,
IV PUSH EA ADDL NEW,5811182,CDM,260,RC,96375,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,20.17,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,40,,35.2,percent of total billed charges,40% of total billed charges,20.17,88,
IV PUSH EA ADDL SAME,5811182,CDM,260,RC,96376,HCPCS,Outpatient,,,108,86.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% 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,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,40.25,86.4,
FLUOROSC EA ADDL HR,6000392,CDM,320,RC,76001,HCPCS,Outpatient,,,449,359.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,359.2,80,,287.36,percent of total billed charges,80% of total billed charges,167.34,37.27,,133.87,percent of total billed charges,37.27% of total billed charges,167.34,37.27,,133.87,percent of total billed charges,37.27% of total billed charges,167.34,37.27,,133.87,percent of total billed charges,37.27% 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,179.6,40,,143.68,percent of total billed charges,40% of total billed charges,167.34,359.2,
ECHO COMPLETE,7442254,CDM,480,RC,93306,HCPCS,Outpatient,,,2257,1805.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1805.6,80,,1444.48,percent of total billed charges,80% of total billed charges,841.18,37.27,,672.94,percent of total billed charges,37.27% of total billed charges,841.18,37.27,,672.94,percent of total billed charges,37.27% of total billed charges,841.18,37.27,,672.94,percent of total billed charges,37.27% of total billed charges,454.86,100,,,fee schedule,100% of APC rate,454.86,100,,,fee schedule,100% of APC rate,454.86,100,,,fee schedule,100% of APC rate,164.01,145,,,fee schedule,145% of CMS fee schedule,454.86,100,,,fee schedule,100% of APC rate,454.86,100,,,fee schedule,100% of APC rate,454.86,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,902.8,40,,722.24,percent of total billed charges,40% of total billed charges,164.01,1805.6,
ABG PUNCTURE,7012032,CDM,300,RC,36600,HCPCS,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,20.76,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110,40,,88,percent of total billed charges,40% of total billed charges,20.76,220,
WD VAC TX <50 W/DME,5612353,CDM,510,RC,97605,HCPCS,Outpatient,,,250,200.00,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,200,80,,160,percent of total billed charges,80% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% of total billed charges,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,33.86,145,,,fee schedule,145% of CMS fee schedule,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,165.06,100,,,fee schedule,100% of APC rate,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,33.86,200,
WD VAC TX >50 W/DME,5612353,CDM,510,RC,97606,HCPCS,Outpatient,,,621.6,497.28,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,497.28,80,,397.82,percent of total billed charges,80% of total billed charges,231.67,37.27,,185.34,percent of total billed charges,37.27% of total billed charges,231.67,37.27,,185.34,percent of total billed charges,37.27% of total billed charges,231.67,37.27,,185.34,percent of total billed charges,37.27% of total billed charges,328.76,100,,,fee schedule,100% of APC rate,328.76,100,,,fee schedule,100% of APC rate,328.76,100,,,fee schedule,100% of APC rate,37.12,145,,,fee schedule,145% of CMS fee schedule,328.76,100,,,fee schedule,100% of APC rate,328.76,100,,,fee schedule,100% of APC rate,328.76,100,,,fee schedule,100% of APC rate,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,37.12,497.28,
OT APPL SPLINT SHORT,6510135,CDM,430,RC,29125,HCPCS,Outpatient,,,211,168.80,GO,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.8,80,,135.04,percent of total billed charges,80% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,55.74,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.4,40,,67.52,percent of total billed charges,40% of total billed charges,55.74,168.8,
OT APPL SPLINT FNGR,6510135,CDM,430,RC,29130,HCPCS,Outpatient,,,211,168.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.8,80,,135.04,percent of total billed charges,80% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,40.93,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.4,40,,67.52,percent of total billed charges,40% of total billed charges,40.93,168.8,
INTUBATION,8830002,CDM,450,RC,31500,HCPCS,Outpatient,,,646,516.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,199.82,145,,,fee schedule,145% of CMS fee schedule,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,258.4,40,,206.72,percent of total billed charges,40% of total billed charges,199.82,516.8,
ER BLOOD TRANSFUSION,5811120,CDM,391,RC,36430,HCPCS,Outpatient,,,1034,827.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,827.2,80,,661.76,percent of total billed charges,80% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,54.09,145,,,fee schedule,145% of CMS fee schedule,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413.6,40,,330.88,percent of total billed charges,40% of total billed charges,54.09,827.2,
PULSE OX SINGLE,7441215,CDM,460,RC,94760,HCPCS,Outpatient,,,48,38.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.51,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,40,,15.36,percent of total billed charges,40% of total billed charges,3.51,38.4,
IV HYDR INITIAL,5811182,CDM,260,RC,96360,HCPCS,Outpatient,,,222,177.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,42.15,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,40,,71.04,percent of total billed charges,40% of total billed charges,42.15,177.6,
IV HYDR EA ADDL,5811182,CDM,260,RC,96361,HCPCS,Outpatient,,,77,61.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,16.3,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,16.3,61.6,
IV INFUSION INIT HR,5811182,CDM,260,RC,96365,HCPCS,Outpatient,,,526,420.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.8,80,,336.64,percent of total billed charges,80% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,81.26,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,40,,168.32,percent of total billed charges,40% of total billed charges,81.26,420.8,
IV INF EA ADDL 1HR,5811182,CDM,260,RC,96366,HCPCS,Outpatient,,,123,98.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,26.98,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,40,,39.36,percent of total billed charges,40% of total billed charges,26.98,98.4,
IV INFUSION SEQ 1HR,5811182,CDM,260,RC,96367,HCPCS,Outpatient,,,134,107.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,37.19,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,40,,42.88,percent of total billed charges,40% of total billed charges,37.19,107.2,
IV INFUSION CONCUR,5811182,CDM,260,RC,96368,HCPCS,Outpatient,,,146,116.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.09,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,26.09,116.8,
INJECTION SUBC OR IM,5811182,CDM,260,RC,96372,HCPCS,Outpatient,,,77,61.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,19.31,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,19.31,61.6,
IV PUSH INITIAL,5811182,CDM,260,RC,96374,HCPCS,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,47.84,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198,40,,158.4,percent of total billed charges,40% of total billed charges,47.84,396,
IV PUSH EA ADDL NEW,5811182,CDM,260,RC,96375,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,20.17,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,40,,35.2,percent of total billed charges,40% of total billed charges,20.17,88,
IV PUSH EA ADDL SAME,5811182,CDM,260,RC,96376,HCPCS,Outpatient,,,108,86.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% 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,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,40.25,86.4,
CRIT CARE 30-74 MIN,8830002,CDM,450,RC,99291,HCPCS,Outpatient,,,1889,1511.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1511.2,80,,1208.96,percent of total billed charges,80% of total billed charges,704.03,37.27,,563.22,percent of total billed charges,37.27% of total billed charges,704.03,37.27,,563.22,percent of total billed charges,37.27% of total billed charges,704.03,37.27,,563.22,percent of total billed charges,37.27% of total billed charges,1331.64,100,,,case rate ,pays based on per visit rate,1331.64,100,,,fee schedule,100% of APC rate,1331.64,100,,,fee schedule,100% of APC rate,600,145,,,fee schedule,145% of CMS fee schedule,1331.64,100,,,fee schedule,100% of APC rate,1331.64,100,,,fee schedule,100% of APC rate,1331.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,755.6,40,,604.48,percent of total billed charges,40% of total billed charges,600,1511.2,
CRIT CARE EA ADDL 30,8830002,CDM,450,RC,99292,HCPCS,Outpatient,,,850,680.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,680,80,,544,percent of total billed charges,80% of total billed charges,316.8,37.27,,253.44,percent of total billed charges,37.27% of total billed charges,316.8,37.27,,253.44,percent of total billed charges,37.27% of total billed charges,316.8,37.27,,253.44,percent of total billed charges,37.27% of total billed charges,600,100,,,case rate ,pays based on per visit rate,600,100,,,case rate ,pays based on per visit rate,600,100,,,case rate ,pays based on per visit rate,600,145,,,fee schedule,145% of CMS fee schedule,600,100,,,case rate,pays based on per visit rate,600,100,,,case rate,pays based on per visit rate,600,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,340,40,,272,percent of total billed charges,40% of total billed charges,316.8,680,
OSS BLOOD TRANSFUS,5811120,CDM,391,RC,36430,HCPCS,Outpatient,,,1034,827.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,827.2,80,,661.76,percent of total billed charges,80% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,54.09,145,,,fee schedule,145% of CMS fee schedule,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413.6,40,,330.88,percent of total billed charges,40% of total billed charges,54.09,827.2,
IV HYDR INITIAL,5811182,CDM,260,RC,96360,HCPCS,Outpatient,,,222,177.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,42.15,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,40,,71.04,percent of total billed charges,40% of total billed charges,42.15,177.6,
IV HYDR EA ADDL,5811182,CDM,260,RC,96361,HCPCS,Outpatient,,,77,61.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,16.3,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,16.3,61.6,
IV INFUSION INIT HR,5811182,CDM,260,RC,96365,HCPCS,Outpatient,,,526,420.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.8,80,,336.64,percent of total billed charges,80% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,81.26,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,40,,168.32,percent of total billed charges,40% of total billed charges,81.26,420.8,
IV INF EA ADDL 1 HR,5811182,CDM,260,RC,96366,HCPCS,Outpatient,,,123,98.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,26.98,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,40,,39.36,percent of total billed charges,40% of total billed charges,26.98,98.4,
INJECTION SUBC OR IM,5811182,CDM,260,RC,96372,HCPCS,Outpatient,,,77,61.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,19.31,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,19.31,61.6,
IV PUSH INITIAL,5811182,CDM,260,RC,96374,HCPCS,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,47.84,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198,40,,158.4,percent of total billed charges,40% of total billed charges,47.84,396,
IV PUSH EA ADDL NEW,5811182,CDM,260,RC,96375,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,20.17,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,40,,35.2,percent of total billed charges,40% of total billed charges,20.17,88,
IV PUSH EA ADDL SAME,5811182,CDM,260,RC,96376,HCPCS,Outpatient,,,108,86.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% 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,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,40.25,86.4,
PORT FLUSH/DRESS CHG,5617243,CDM,940,RC,96523,HCPCS,Outpatient,,,128,102.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,47.71,37.27,,38.17,percent of total billed charges,37.27% of total billed charges,47.71,37.27,,38.17,percent of total billed charges,37.27% of total billed charges,47.71,37.27,,38.17,percent of total billed charges,37.27% of total billed charges,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,32.07,145,,,fee schedule,145% of CMS fee schedule,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,40,,40.96,percent of total billed charges,40% of total billed charges,32.07,102.4,
PNUEM ADMINISTRATION,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,73,58.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,27.21,58.4,
AMIDATE 40MG/20ML,6400014,CDM,250,RC,,,Outpatient,,,79.1,63.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.28,80,,50.62,percent of total billed charges,80% of total billed charges,29.48,37.27,,23.58,percent of total billed charges,37.27% of total billed charges,29.48,37.27,,23.58,percent of total billed charges,37.27% of total billed charges,29.48,37.27,,23.58,percent of total billed charges,37.27% 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,31.64,40,,25.31,percent of total billed charges,40% of total billed charges,29.48,63.28,
MUCINEX D,5880901,CDM,637,RC,,,Outpatient,,,2.2,1.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.76,80,,1.41,percent of total billed charges,80% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% of total billed charges,0.82,37.27,,0.66,percent of total billed charges,37.27% 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,0.88,40,,0.7,percent of total billed charges,40% of total billed charges,0.82,1.76,
GRISEOFULV 125MG/5ML,5880901,CDM,637,RC,,,Outpatient,,,251.3,201.04,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.04,80,,160.83,percent of total billed charges,80% of total billed charges,93.66,37.27,,74.93,percent of total billed charges,37.27% of total billed charges,93.66,37.27,,74.93,percent of total billed charges,37.27% of total billed charges,93.66,37.27,,74.93,percent of total billed charges,37.27% 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,100.52,40,,80.42,percent of total billed charges,40% of total billed charges,93.66,201.04,
DESMOPRESSIN 0.1MG,5880901,CDM,637,RC,,,Outpatient,,,25.1,20.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.08,80,,16.06,percent of total billed charges,80% of total billed charges,9.35,37.27,,7.48,percent of total billed charges,37.27% of total billed charges,9.35,37.27,,7.48,percent of total billed charges,37.27% of total billed charges,9.35,37.27,,7.48,percent of total billed charges,37.27% 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,10.04,40,,8.03,percent of total billed charges,40% of total billed charges,9.35,20.08,
DESMOPRESSIN 0.2MG,5880901,CDM,637,RC,,,Outpatient,,,32.55,26.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.04,80,,20.83,percent of total billed charges,80% of total billed charges,12.13,37.27,,9.7,percent of total billed charges,37.27% of total billed charges,12.13,37.27,,9.7,percent of total billed charges,37.27% of total billed charges,12.13,37.27,,9.7,percent of total billed charges,37.27% 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,13.02,40,,10.42,percent of total billed charges,40% of total billed charges,12.13,26.04,
DEFEROXAMINE 2GM VL,6065130,CDM,636,RC,J0895,HCPCS,Outpatient,,,195.05,156.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.04,80,,124.83,percent of total billed charges,80% of total billed charges,72.7,37.27,,58.16,percent of total billed charges,37.27% of total billed charges,72.7,37.27,,58.16,percent of total billed charges,37.27% of total billed charges,72.7,37.27,,58.16,percent of total billed charges,37.27% 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,78.02,40,,62.42,percent of total billed charges,40% of total billed charges,72.7,156.04,
LYRICA 25MG CAP,5880901,CDM,637,RC,,,Outpatient,,,13.6,10.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.88,80,,8.7,percent of total billed charges,80% of total billed charges,5.07,37.27,,4.06,percent of total billed charges,37.27% of total billed charges,5.07,37.27,,4.06,percent of total billed charges,37.27% of total billed charges,5.07,37.27,,4.06,percent of total billed charges,37.27% 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,5.44,40,,4.35,percent of total billed charges,40% of total billed charges,5.07,10.88,
PLATELETS LR PER UNI,7051695,CDM,390,RC,P9031,HCPCS,Outpatient,,,419,335.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,335.2,80,,268.16,percent of total billed charges,80% of total billed charges,156.16,37.27,,124.93,percent of total billed charges,37.27% of total billed charges,156.16,37.27,,124.93,percent of total billed charges,37.27% of total billed charges,156.16,37.27,,124.93,percent of total billed charges,37.27% of total billed charges,130.88,100,,,fee schedule,100% of APC rate,130.88,100,,,fee schedule,100% of APC rate,130.88,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,130.88,100,,,fee schedule,100% of APC rate,130.88,100,,,fee schedule,100% of APC rate,130.88,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,167.6,40,,134.08,percent of total billed charges,40% of total billed charges,130.88,335.2,
RBC LEUKOCYTE REDUCE,7051694,CDM,381,RC,P9016,HCPCS,Outpatient,,,714,571.20,BL,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,571.2,80,,456.96,percent of total billed charges,80% of total billed charges,266.11,37.27,,212.89,percent of total billed charges,37.27% of total billed charges,266.11,37.27,,212.89,percent of total billed charges,37.27% of total billed charges,266.11,37.27,,212.89,percent of total billed charges,37.27% of total billed charges,180.82,100,,,fee schedule,100% of APC rate,180.82,100,,,fee schedule,100% of APC rate,180.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,180.82,100,,,fee schedule,100% of APC rate,180.82,100,,,fee schedule,100% of APC rate,180.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,285.6,40,,228.48,percent of total billed charges,40% of total billed charges,180.82,571.2,
ACULAR LS 0.4% OPTH,5880901,CDM,637,RC,,,Outpatient,,,630.2,504.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,504.16,80,,403.33,percent of total billed charges,80% of total billed charges,234.88,37.27,,187.9,percent of total billed charges,37.27% of total billed charges,234.88,37.27,,187.9,percent of total billed charges,37.27% of total billed charges,234.88,37.27,,187.9,percent of total billed charges,37.27% 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,252.08,40,,201.66,percent of total billed charges,40% of total billed charges,234.88,504.16,
LOVASA CAPSULE,5880901,CDM,637,RC,,,Outpatient,,,13.8,11.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.04,80,,8.83,percent of total billed charges,80% of total billed charges,5.14,37.27,,4.11,percent of total billed charges,37.27% of total billed charges,5.14,37.27,,4.11,percent of total billed charges,37.27% of total billed charges,5.14,37.27,,4.11,percent of total billed charges,37.27% 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,5.52,40,,4.42,percent of total billed charges,40% of total billed charges,5.14,11.04,
FERRLECIT 62.5/5ML,6400014,CDM,250,RC,J2916,HCPCS,Outpatient,,,146.65,117.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.32,80,,93.86,percent of total billed charges,80% of total billed charges,54.66,37.27,,43.73,percent of total billed charges,37.27% of total billed charges,54.66,37.27,,43.73,percent of total billed charges,37.27% of total billed charges,54.66,37.27,,43.73,percent of total billed charges,37.27% 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,58.66,40,,46.93,percent of total billed charges,40% of total billed charges,54.66,117.32,
ZEMPLAR 1MCG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,46.15,36.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.92,80,,29.54,percent of total billed charges,80% of total billed charges,17.2,37.27,,13.76,percent of total billed charges,37.27% of total billed charges,17.2,37.27,,13.76,percent of total billed charges,37.27% of total billed charges,17.2,37.27,,13.76,percent of total billed charges,37.27% 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,18.46,40,,14.77,percent of total billed charges,40% of total billed charges,17.2,36.92,
VACCINE ADMIN 1ST,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,27.36,128,
NASOTRACHEAL SUCTION,8830002,CDM,450,RC,31720,HCPCS,Outpatient,,,410,328.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328,80,,262.4,percent of total billed charges,80% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,67.83,145,,,fee schedule,145% of CMS fee schedule,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164,40,,131.2,percent of total billed charges,40% of total billed charges,67.83,328,
BLOOD SPEC FROM IV,8830002,CDM,450,RC,36592,HCPCS,Outpatient,,,118,94.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,38.18,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,40,,37.76,percent of total billed charges,40% of total billed charges,38.18,105.32,
PROC LEVEL 1,8830002,CDM,450,RC,SURG,HCPCS,Outpatient,,,1210,968.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968,80,,774.4,percent of total billed charges,80% of total billed charges,450.97,37.27,,360.78,percent of total billed charges,37.27% of total billed charges,450.97,37.27,,360.78,percent of total billed charges,37.27% of total billed charges,450.97,37.27,,360.78,percent of total billed charges,37.27% 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,484,40,,387.2,percent of total billed charges,40% of total billed charges,450.97,968,
PROC LEVEL 2,8830002,CDM,450,RC,SURG,HCPCS,Outpatient,,,1320,1056.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1056,80,,844.8,percent of total billed charges,80% of total billed charges,491.96,37.27,,393.57,percent of total billed charges,37.27% of total billed charges,491.96,37.27,,393.57,percent of total billed charges,37.27% of total billed charges,491.96,37.27,,393.57,percent of total billed charges,37.27% 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,528,40,,422.4,percent of total billed charges,40% of total billed charges,491.96,1056,
PROC LEVEL 3,8830002,CDM,450,RC,SURG,HCPCS,Outpatient,,,1430,1144.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1144,80,,915.2,percent of total billed charges,80% of total billed charges,532.96,37.27,,426.37,percent of total billed charges,37.27% of total billed charges,532.96,37.27,,426.37,percent of total billed charges,37.27% of total billed charges,532.96,37.27,,426.37,percent of total billed charges,37.27% 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,572,40,,457.6,percent of total billed charges,40% of total billed charges,532.96,1144,
PROC LEVEL 4,8830002,CDM,450,RC,SURG,HCPCS,Outpatient,,,2474,1979.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1979.2,80,,1583.36,percent of total billed charges,80% of total billed charges,922.06,37.27,,737.65,percent of total billed charges,37.27% of total billed charges,922.06,37.27,,737.65,percent of total billed charges,37.27% of total billed charges,922.06,37.27,,737.65,percent of total billed charges,37.27% 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,989.6,40,,791.68,percent of total billed charges,40% of total billed charges,922.06,1979.2,
LEFT W/O BEING SEEN,8830002,CDM,450,RC,99281,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,673.2,100,,,case rate ,pays based on per visit rate,673.2,100,,,fee schedule,100% of APC rate,673.2,100,,,fee schedule,100% of APC rate,600,145,,,fee schedule,145% of CMS fee schedule,673.2,100,,,fee schedule,100% of APC rate,673.2,100,,,fee schedule,100% of APC rate,673.2,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600,673.2,
GI LAVAGE,8830002,CDM,450,RC,43753,HCPCS,Outpatient,,,295,236.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236,80,,188.8,percent of total billed charges,80% of total billed charges,109.95,37.27,,87.96,percent of total billed charges,37.27% of total billed charges,109.95,37.27,,87.96,percent of total billed charges,37.27% of total billed charges,109.95,37.27,,87.96,percent of total billed charges,37.27% of total billed charges,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,30.78,145,,,fee schedule,145% of CMS fee schedule,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,258.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,118,40,,94.4,percent of total billed charges,40% of total billed charges,30.78,258.79,
HEP B ADMINISTRATION,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,73,58.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,27.21,58.4,
VAC/TOXOID ADM EA AD,9397936,CDM,771,RC,90472,HCPCS,Outpatient,,,73,58.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.62,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,19.62,58.4,
BLOOD SPEC FROM CATH,5612346,CDM,761,RC,36592,HCPCS,Outpatient,,,146,116.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,38.18,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,38.18,116.8,
ENDO OR EA ADDL PROC,8602000,CDM,750,RC,SURG,HCPCS,Outpatient,,,1686,1348.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1348.8,80,,1079.04,percent of total billed charges,80% of total billed charges,628.37,37.27,,502.7,percent of total billed charges,37.27% of total billed charges,628.37,37.27,,502.7,percent of total billed charges,37.27% of total billed charges,628.37,37.27,,502.7,percent of total billed charges,37.27% 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,674.4,40,,539.52,percent of total billed charges,40% of total billed charges,628.37,1348.8,
COLORECTAL SCREEN,8602000,CDM,750,RC,SURG,HCPCS,Outpatient,,,889,711.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,711.2,80,,568.96,percent of total billed charges,80% of total billed charges,331.33,37.27,,265.06,percent of total billed charges,37.27% of total billed charges,331.33,37.27,,265.06,percent of total billed charges,37.27% of total billed charges,331.33,37.27,,265.06,percent of total billed charges,37.27% 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,355.6,40,,284.48,percent of total billed charges,40% of total billed charges,331.33,711.2,
ADVAIR HFA 45/21 INH,6400014,CDM,250,RC,,,Outpatient,,,715.2,572.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,572.16,80,,457.73,percent of total billed charges,80% of total billed charges,266.56,37.27,,213.25,percent of total billed charges,37.27% of total billed charges,266.56,37.27,,213.25,percent of total billed charges,37.27% of total billed charges,266.56,37.27,,213.25,percent of total billed charges,37.27% 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,286.08,40,,228.86,percent of total billed charges,40% of total billed charges,266.56,572.16,
STALEVO 150MG TAB,6400014,CDM,250,RC,,,Outpatient,,,31.25,25.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25,80,,20,percent of total billed charges,80% of total billed charges,11.65,37.27,,9.32,percent of total billed charges,37.27% of total billed charges,11.65,37.27,,9.32,percent of total billed charges,37.27% of total billed charges,11.65,37.27,,9.32,percent of total billed charges,37.27% 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,12.5,40,,10,percent of total billed charges,40% of total billed charges,11.65,25,
LEVEMIR,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,126.05,100.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.84,80,,80.67,percent of total billed charges,80% of total billed charges,46.98,37.27,,37.58,percent of total billed charges,37.27% of total billed charges,46.98,37.27,,37.58,percent of total billed charges,37.27% of total billed charges,46.98,37.27,,37.58,percent of total billed charges,37.27% 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,50.42,40,,40.34,percent of total billed charges,40% of total billed charges,46.98,100.84,
ROBITUSSIN CF LIQUID,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
OPCE MED DIRECT ADMT,8399990,CDM,762,RC,G0379,HCPCS,Outpatient,,,3983,3186.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3186.4,80,,2549.12,percent of total billed charges,80% of total billed charges,1484.46,37.27,,1187.57,percent of total billed charges,37.27% of total billed charges,1484.46,37.27,,1187.57,percent of total billed charges,37.27% of total billed charges,1484.46,37.27,,1187.57,percent of total billed charges,37.27% of total billed charges,529.59,100,,,fee schedule,100% of APC rate,529.59,100,,,fee schedule,100% of APC rate,529.59,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,529.59,100,,,fee schedule,100% of APC rate,529.59,100,,,fee schedule,100% of APC rate,529.59,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1593.2,40,,1274.56,percent of total billed charges,40% of total billed charges,529.59,3186.4,
MED OBV PER HR,8399990,CDM,762,RC,G0378,HCPCS,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% 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,34,40,,27.2,percent of total billed charges,40% of total billed charges,31.68,68,
VACCINE ADMIN 1ST,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,27.36,128,
RBC IRRADIATED PER U,7051695,CDM,390,RC,P9038,HCPCS,Outpatient,,,427.58,342.06,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,342.06,80,,273.65,percent of total billed charges,80% of total billed charges,159.36,37.27,,127.49,percent of total billed charges,37.27% of total billed charges,159.36,37.27,,127.49,percent of total billed charges,37.27% of total billed charges,159.36,37.27,,127.49,percent of total billed charges,37.27% of total billed charges,216.72,100,,,fee schedule,100% of APC rate,216.72,100,,,fee schedule,100% of APC rate,216.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,216.72,100,,,fee schedule,100% of APC rate,216.72,100,,,fee schedule,100% of APC rate,216.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.03,40,,136.82,percent of total billed charges,40% of total billed charges,159.36,342.06,
PLATELETS PER UNIT,7051695,CDM,390,RC,P9019,HCPCS,Outpatient,,,118,94.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,65.04,100,,,fee schedule,100% of APC rate,65.04,100,,,fee schedule,100% of APC rate,65.04,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,65.04,100,,,fee schedule,100% of APC rate,65.04,100,,,fee schedule,100% of APC rate,65.04,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.2,40,,37.76,percent of total billed charges,40% of total billed charges,43.98,94.4,
BC POWDER PKT,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
DAKIN'S SOLN (OZ),6400014,CDM,250,RC,,,Outpatient,,,2.95,2.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,80,,1.89,percent of total billed charges,80% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% 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,1.18,40,,0.94,percent of total billed charges,40% of total billed charges,1.1,2.36,
CAFFEINE INJ 500MG,6400014,CDM,250,RC,,,Outpatient,,,139.35,111.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.48,80,,89.18,percent of total billed charges,80% of total billed charges,51.94,37.27,,41.55,percent of total billed charges,37.27% of total billed charges,51.94,37.27,,41.55,percent of total billed charges,37.27% of total billed charges,51.94,37.27,,41.55,percent of total billed charges,37.27% 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,55.74,40,,44.59,percent of total billed charges,40% of total billed charges,51.94,111.48,
CELLUVISC OPTH DROPS,6400014,CDM,250,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
NORETHINDRONE 5MG,6400014,CDM,250,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
VITAMIN K 100MCG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
MAG TAB 64MG,5880901,CDM,637,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
BLADES/ORTHO,5801832,CDM,272,RC,,,Outpatient,,,94,75.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,75.2,80,,60.16,percent of total billed charges,80% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% of total billed charges,35.03,37.27,,28.02,percent of total billed charges,37.27% 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,37.6,40,,30.08,percent of total billed charges,40% of total billed charges,35.03,75.2,
UTERINE MANIPULATOR,5645742,CDM,270,RC,,,Outpatient,,,67,53.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% 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,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,24.97,53.6,
CAUTERY SUCT ABLATOR,5645742,CDM,270,RC,,,Outpatient,,,218,174.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% 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,87.2,40,,69.76,percent of total billed charges,40% of total billed charges,81.25,174.4,
TRIAMCINOLONE .1% LN,6400014,CDM,250,RC,,,Outpatient,,,261.9,209.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,209.52,80,,167.62,percent of total billed charges,80% of total billed charges,97.61,37.27,,78.09,percent of total billed charges,37.27% of total billed charges,97.61,37.27,,78.09,percent of total billed charges,37.27% of total billed charges,97.61,37.27,,78.09,percent of total billed charges,37.27% 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,104.76,40,,83.81,percent of total billed charges,40% of total billed charges,97.61,209.52,
CPAP/BIPAP,7439094,CDM,410,RC,94660,HCPCS,Outpatient,,,271,216.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,216.8,80,,173.44,percent of total billed charges,80% of total billed charges,101,37.27,,80.8,percent of total billed charges,37.27% of total billed charges,101,37.27,,80.8,percent of total billed charges,37.27% of total billed charges,101,37.27,,80.8,percent of total billed charges,37.27% of total billed charges,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,51.82,145,,,fee schedule,145% of CMS fee schedule,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.4,40,,86.72,percent of total billed charges,40% of total billed charges,51.82,216.8,
CEFUROXIME 1500MG,6065130,CDM,636,RC,J0697,HCPCS,Outpatient,,,22.93,18.34,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.34,80,,14.67,percent of total billed charges,80% of total billed charges,8.55,37.27,,6.84,percent of total billed charges,37.27% of total billed charges,8.55,37.27,,6.84,percent of total billed charges,37.27% of total billed charges,8.55,37.27,,6.84,percent of total billed charges,37.27% 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,9.17,40,,7.34,percent of total billed charges,40% of total billed charges,8.55,18.34,
MORPHINE 15MG IR,6400014,CDM,250,RC,A9270,HCPCS,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
MULTAQ 400MG TAB,6400014,CDM,250,RC,,,Outpatient,,,54.4,43.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.52,80,,34.82,percent of total billed charges,80% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% of total billed charges,20.27,37.27,,16.22,percent of total billed charges,37.27% 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,21.76,40,,17.41,percent of total billed charges,40% of total billed charges,20.27,43.52,
CO2 DETECTOR,5645742,CDM,270,RC,,,Outpatient,,,60,48.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,80,,38.4,percent of total billed charges,80% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% of total billed charges,22.36,37.27,,17.89,percent of total billed charges,37.27% 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,24,40,,19.2,percent of total billed charges,40% of total billed charges,22.36,48,
FLUTTER VALVE DEVICE,5645742,CDM,270,RC,,,Outpatient,,,131,104.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% 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,52.4,40,,41.92,percent of total billed charges,40% of total billed charges,48.82,104.8,
CEREBYX 100MG/2ML,6065130,CDM,636,RC,Q2009,HCPCS,Outpatient,,,165.4,132.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.32,80,,105.86,percent of total billed charges,80% of total billed charges,61.64,37.27,,49.31,percent of total billed charges,37.27% of total billed charges,61.64,37.27,,49.31,percent of total billed charges,37.27% of total billed charges,61.64,37.27,,49.31,percent of total billed charges,37.27% of total billed charges,3.2,100,,,fee schedule,100% of APC rate,3.2,100,,,fee schedule,100% of APC rate,3.2,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,3.2,100,,,fee schedule,100% of APC rate,3.2,100,,,fee schedule,100% of APC rate,3.2,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.16,40,,52.93,percent of total billed charges,40% of total billed charges,3.2,132.32,
COREG CR 40MG CAP,5880901,CDM,637,RC,,,Outpatient,,,16.55,13.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.24,80,,10.59,percent of total billed charges,80% of total billed charges,6.17,37.27,,4.94,percent of total billed charges,37.27% of total billed charges,6.17,37.27,,4.94,percent of total billed charges,37.27% of total billed charges,6.17,37.27,,4.94,percent of total billed charges,37.27% 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,6.62,40,,5.3,percent of total billed charges,40% of total billed charges,6.17,13.24,
NUVIGIL 150MG TAB,6400014,CDM,250,RC,,,Outpatient,,,114,91.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.2,80,,72.96,percent of total billed charges,80% of total billed charges,42.49,37.27,,33.99,percent of total billed charges,37.27% of total billed charges,42.49,37.27,,33.99,percent of total billed charges,37.27% of total billed charges,42.49,37.27,,33.99,percent of total billed charges,37.27% 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,45.6,40,,36.48,percent of total billed charges,40% of total billed charges,42.49,91.2,
ZYRTEC D 12HR,6400014,CDM,250,RC,,,Outpatient,,,2.65,2.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.12,80,,1.7,percent of total billed charges,80% of total billed charges,0.99,37.27,,0.79,percent of total billed charges,37.27% of total billed charges,0.99,37.27,,0.79,percent of total billed charges,37.27% of total billed charges,0.99,37.27,,0.79,percent of total billed charges,37.27% 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,1.06,40,,0.85,percent of total billed charges,40% of total billed charges,0.99,2.12,
NUCYNTA 50MG TAB,6400014,CDM,250,RC,A9270,HCPCS,Outpatient,,,30.7,24.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.56,80,,19.65,percent of total billed charges,80% of total billed charges,11.44,37.27,,9.15,percent of total billed charges,37.27% of total billed charges,11.44,37.27,,9.15,percent of total billed charges,37.27% of total billed charges,11.44,37.27,,9.15,percent of total billed charges,37.27% 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,12.28,40,,9.82,percent of total billed charges,40% of total billed charges,11.44,24.56,
NEO-POLYMB-DEXA OINT,6400014,CDM,250,RC,,,Outpatient,,,67.7,54.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.16,80,,43.33,percent of total billed charges,80% of total billed charges,25.23,37.27,,20.18,percent of total billed charges,37.27% of total billed charges,25.23,37.27,,20.18,percent of total billed charges,37.27% of total billed charges,25.23,37.27,,20.18,percent of total billed charges,37.27% 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,27.08,40,,21.66,percent of total billed charges,40% of total billed charges,25.23,54.16,
SEROQUEL XR  150MG,6400014,CDM,250,RC,A9270,HCPCS,Outpatient,,,60.3,48.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.24,80,,38.59,percent of total billed charges,80% of total billed charges,22.47,37.27,,17.98,percent of total billed charges,37.27% of total billed charges,22.47,37.27,,17.98,percent of total billed charges,37.27% of total billed charges,22.47,37.27,,17.98,percent of total billed charges,37.27% 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,24.12,40,,19.3,percent of total billed charges,40% of total billed charges,22.47,48.24,
LORTAB 5/500 TAB,5880901,CDM,637,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
TRIZIVIR TABLET,6400014,CDM,250,RC,,,Outpatient,,,91.4,73.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.12,80,,58.5,percent of total billed charges,80% of total billed charges,34.06,37.27,,27.25,percent of total billed charges,37.27% of total billed charges,34.06,37.27,,27.25,percent of total billed charges,37.27% of total billed charges,34.06,37.27,,27.25,percent of total billed charges,37.27% 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,36.56,40,,29.25,percent of total billed charges,40% of total billed charges,34.06,73.12,
COENZ Q10 100MG CAP,5880901,CDM,637,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
SOD BICARB 325MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CEPHADYN 50/650 TAB,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
H1N1 ADMINISTRATION,9397936,CDM,771,RC,,,Outpatient,,,62.23,49.78,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.78,80,,39.82,percent of total billed charges,80% of total billed charges,23.19,37.27,,18.55,percent of total billed charges,37.27% of total billed charges,23.19,37.27,,18.55,percent of total billed charges,37.27% of total billed charges,23.19,37.27,,18.55,percent of total billed charges,37.27% 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,24.89,40,,19.91,percent of total billed charges,40% of total billed charges,23.19,49.78,
CHLOROTHIAZIDE 250MG,5880901,CDM,637,RC,,,Outpatient,,,2.35,1.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.88,80,,1.5,percent of total billed charges,80% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% of total billed charges,0.88,37.27,,0.7,percent of total billed charges,37.27% 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,0.94,40,,0.75,percent of total billed charges,40% of total billed charges,0.88,1.88,
CEFOXITIN 1 GM INJ,6065130,CDM,636,RC,J0694,HCPCS,Outpatient,,,38.25,30.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.6,80,,24.48,percent of total billed charges,80% of total billed charges,14.26,37.27,,11.41,percent of total billed charges,37.27% of total billed charges,14.26,37.27,,11.41,percent of total billed charges,37.27% of total billed charges,14.26,37.27,,11.41,percent of total billed charges,37.27% 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,15.3,40,,12.24,percent of total billed charges,40% of total billed charges,14.26,30.6,
CEFOXITIN 2 GM INJ,6065130,CDM,636,RC,J0694,HCPCS,Outpatient,,,76.7,61.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.36,80,,49.09,percent of total billed charges,80% of total billed charges,28.59,37.27,,22.87,percent of total billed charges,37.27% of total billed charges,28.59,37.27,,22.87,percent of total billed charges,37.27% of total billed charges,28.59,37.27,,22.87,percent of total billed charges,37.27% 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,30.68,40,,24.54,percent of total billed charges,40% of total billed charges,28.59,61.36,
NOROXIN 400MG TAB,6400014,CDM,250,RC,,,Outpatient,,,18.9,15.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.12,80,,12.1,percent of total billed charges,80% of total billed charges,7.04,37.27,,5.63,percent of total billed charges,37.27% of total billed charges,7.04,37.27,,5.63,percent of total billed charges,37.27% of total billed charges,7.04,37.27,,5.63,percent of total billed charges,37.27% 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,7.56,40,,6.05,percent of total billed charges,40% of total billed charges,7.04,15.12,
TETRA,7000029,CDM,301,RC,,,Outpatient,,,482.85,386.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,386.28,80,,309.02,percent of total billed charges,80% of total billed charges,179.96,37.27,,143.97,percent of total billed charges,37.27% of total billed charges,179.96,37.27,,143.97,percent of total billed charges,37.27% of total billed charges,179.96,37.27,,143.97,percent of total billed charges,37.27% 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,193.14,40,,154.51,percent of total billed charges,40% of total billed charges,179.96,386.28,
SAVELLA 50MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,33.2,26.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.56,80,,21.25,percent of total billed charges,80% of total billed charges,12.37,37.27,,9.9,percent of total billed charges,37.27% of total billed charges,12.37,37.27,,9.9,percent of total billed charges,37.27% of total billed charges,12.37,37.27,,9.9,percent of total billed charges,37.27% 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,13.28,40,,10.62,percent of total billed charges,40% of total billed charges,12.37,26.56,
PRED FORTE 10ML,6400014,CDM,250,RC,,,Outpatient,,,98.9,79.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.12,80,,63.3,percent of total billed charges,80% of total billed charges,36.86,37.27,,29.49,percent of total billed charges,37.27% of total billed charges,36.86,37.27,,29.49,percent of total billed charges,37.27% of total billed charges,36.86,37.27,,29.49,percent of total billed charges,37.27% 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,39.56,40,,31.65,percent of total billed charges,40% of total billed charges,36.86,79.12,
PRED FORTE 15ML,6400014,CDM,250,RC,,,Outpatient,,,100,80.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% 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,40,40,,32,percent of total billed charges,40% of total billed charges,37.27,80,
XOPENEX HFA INHALER,6065130,CDM,636,RC,,,Outpatient,,,159,127.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.2,80,,101.76,percent of total billed charges,80% of total billed charges,59.26,37.27,,47.41,percent of total billed charges,37.27% of total billed charges,59.26,37.27,,47.41,percent of total billed charges,37.27% of total billed charges,59.26,37.27,,47.41,percent of total billed charges,37.27% 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,63.6,40,,50.88,percent of total billed charges,40% of total billed charges,59.26,127.2,
TOVIAZ 4MG ER TAB,6400014,CDM,250,RC,,,Outpatient,,,51.35,41.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.08,80,,32.86,percent of total billed charges,80% of total billed charges,19.14,37.27,,15.31,percent of total billed charges,37.27% of total billed charges,19.14,37.27,,15.31,percent of total billed charges,37.27% of total billed charges,19.14,37.27,,15.31,percent of total billed charges,37.27% 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,20.54,40,,16.43,percent of total billed charges,40% of total billed charges,19.14,41.08,
PRELONE 15MG/5ML(5ML,6065130,CDM,636,RC,J7510,HCPCS,Outpatient,,,8.2,6.56,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.56,80,,5.25,percent of total billed charges,80% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% of total billed charges,3.06,37.27,,2.45,percent of total billed charges,37.27% 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,3.28,40,,2.62,percent of total billed charges,40% of total billed charges,3.06,6.56,
REMERON 45MG SOLTAB,6400014,CDM,250,RC,,,Outpatient,,,11.8,9.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.44,80,,7.55,percent of total billed charges,80% of total billed charges,4.4,37.27,,3.52,percent of total billed charges,37.27% of total billed charges,4.4,37.27,,3.52,percent of total billed charges,37.27% of total billed charges,4.4,37.27,,3.52,percent of total billed charges,37.27% 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,4.72,40,,3.78,percent of total billed charges,40% of total billed charges,4.4,9.44,
DELESTROGEN 40MG/ML,6065130,CDM,636,RC,J1380,HCPCS,Outpatient,,,253.95,203.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203.16,80,,162.53,percent of total billed charges,80% of total billed charges,94.65,37.27,,75.72,percent of total billed charges,37.27% of total billed charges,94.65,37.27,,75.72,percent of total billed charges,37.27% of total billed charges,94.65,37.27,,75.72,percent of total billed charges,37.27% 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,101.58,40,,81.26,percent of total billed charges,40% of total billed charges,94.65,203.16,
SEROQUEL XR 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,33.6,26.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,80,,21.5,percent of total billed charges,80% of total billed charges,12.52,37.27,,10.02,percent of total billed charges,37.27% of total billed charges,12.52,37.27,,10.02,percent of total billed charges,37.27% of total billed charges,12.52,37.27,,10.02,percent of total billed charges,37.27% 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,13.44,40,,10.75,percent of total billed charges,40% of total billed charges,12.52,26.88,
MRI UPPER EXT W/O,6212047,CDM,610,RC,73221,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,184.18,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,184.18,2412.8,
MRI UPPER EXT W/CONT,6212047,CDM,610,RC,73222,HCPCS,Outpatient,,,3290,2632.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2632,80,,2105.6,percent of total billed charges,80% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,312.42,145,,,fee schedule,145% of CMS fee schedule,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,660.16,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,40,,1052.8,percent of total billed charges,40% of total billed charges,312.42,2632,
MRI UPPER EXT W&W/O,6212047,CDM,610,RC,73223,HCPCS,Outpatient,,,3564,2851.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,377.54,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,317.08,2851.2,
CETAPHIL CLEANSER,5880901,CDM,637,RC,,,Outpatient,,,11.98,9.58,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.58,80,,7.66,percent of total billed charges,80% of total billed charges,4.46,37.27,,3.57,percent of total billed charges,37.27% of total billed charges,4.46,37.27,,3.57,percent of total billed charges,37.27% of total billed charges,4.46,37.27,,3.57,percent of total billed charges,37.27% 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,4.79,40,,3.83,percent of total billed charges,40% of total billed charges,4.46,9.58,
OSSEOUS SURVEY INF,6000392,CDM,320,RC,77076,HCPCS,Outpatient,,,293,234.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.4,80,,187.52,percent of total billed charges,80% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,94.54,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.2,40,,93.76,percent of total billed charges,40% of total billed charges,90.64,234.4,
DOXAZOSIN MES 2MG,5880901,CDM,637,RC,,,Outpatient,,,12.8,10.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,80,,8.19,percent of total billed charges,80% of total billed charges,4.77,37.27,,3.82,percent of total billed charges,37.27% of total billed charges,4.77,37.27,,3.82,percent of total billed charges,37.27% of total billed charges,4.77,37.27,,3.82,percent of total billed charges,37.27% 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,5.12,40,,4.1,percent of total billed charges,40% of total billed charges,4.77,10.24,
UE INFANT 2+VWS,6000392,CDM,320,RC,73092,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,30.57,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,30.57,264,
LE INFANT 2+VWS,6000392,CDM,320,RC,73592,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,30.57,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,30.57,264,
OSSEOUS SURVEY COMP,6000392,CDM,320,RC,77075,HCPCS,Outpatient,,,341,272.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,93.7,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.4,40,,109.12,percent of total billed charges,40% of total billed charges,90.64,272.8,
OSSEOUS SURVEY LIMIT,6000392,CDM,320,RC,77074,HCPCS,Outpatient,,,341,272.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,56.78,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.4,40,,109.12,percent of total billed charges,40% of total billed charges,56.78,272.8,
LIOTHYRONINE 5MCG TA,5880901,CDM,637,RC,,,Outpatient,,,2.7,2.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,80,,1.73,percent of total billed charges,80% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% 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,1.08,40,,0.86,percent of total billed charges,40% of total billed charges,1.01,2.16,
ALDEX AN 5MG CHEW TB,6400014,CDM,250,RC,,,Outpatient,,,8.5,6.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.8,80,,5.44,percent of total billed charges,80% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% 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,3.4,40,,2.72,percent of total billed charges,40% of total billed charges,3.17,6.8,
INTEGRA PLUS CAP,5880901,CDM,637,RC,,,Outpatient,,,2.25,1.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,80,,1.44,percent of total billed charges,80% of total billed charges,0.84,37.27,,0.67,percent of total billed charges,37.27% of total billed charges,0.84,37.27,,0.67,percent of total billed charges,37.27% of total billed charges,0.84,37.27,,0.67,percent of total billed charges,37.27% 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,0.9,40,,0.72,percent of total billed charges,40% of total billed charges,0.84,1.8,
TRILIPIX 135MG CAP,6400014,CDM,250,RC,,,Outpatient,,,23.5,18.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.8,80,,15.04,percent of total billed charges,80% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% of total billed charges,8.76,37.27,,7.01,percent of total billed charges,37.27% 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,9.4,40,,7.52,percent of total billed charges,40% of total billed charges,8.76,18.8,
VAZOTAN SUSPENSION,6400014,CDM,250,RC,,,Outpatient,,,70.7,56.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.56,80,,45.25,percent of total billed charges,80% of total billed charges,26.35,37.27,,21.08,percent of total billed charges,37.27% of total billed charges,26.35,37.27,,21.08,percent of total billed charges,37.27% of total billed charges,26.35,37.27,,21.08,percent of total billed charges,37.27% 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,28.28,40,,22.62,percent of total billed charges,40% of total billed charges,26.35,56.56,
CEREFOLIN NAC,6400014,CDM,250,RC,,,Outpatient,,,6.45,5.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.16,80,,4.13,percent of total billed charges,80% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% of total billed charges,2.4,37.27,,1.92,percent of total billed charges,37.27% 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,2.58,40,,2.06,percent of total billed charges,40% of total billed charges,2.4,5.16,
POT.CITRATE 5MEQ,6400014,CDM,250,RC,,,Outpatient,,,6.7,5.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.36,80,,4.29,percent of total billed charges,80% of total billed charges,2.5,37.27,,2,percent of total billed charges,37.27% of total billed charges,2.5,37.27,,2,percent of total billed charges,37.27% of total billed charges,2.5,37.27,,2,percent of total billed charges,37.27% 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,2.68,40,,2.14,percent of total billed charges,40% of total billed charges,2.5,5.36,
POT.CITRATE 10 MEQ,6400014,CDM,250,RC,,,Outpatient,,,9.35,7.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.48,80,,5.98,percent of total billed charges,80% of total billed charges,3.48,37.27,,2.78,percent of total billed charges,37.27% of total billed charges,3.48,37.27,,2.78,percent of total billed charges,37.27% of total billed charges,3.48,37.27,,2.78,percent of total billed charges,37.27% 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,3.74,40,,2.99,percent of total billed charges,40% of total billed charges,3.48,7.48,
ESTER-C 500/55MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
GASTROGRAFIN SOLN.,6400014,CDM,250,RC,,,Outpatient,,,285.15,228.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.12,80,,182.5,percent of total billed charges,80% of total billed charges,106.28,37.27,,85.02,percent of total billed charges,37.27% of total billed charges,106.28,37.27,,85.02,percent of total billed charges,37.27% of total billed charges,106.28,37.27,,85.02,percent of total billed charges,37.27% 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,114.06,40,,91.25,percent of total billed charges,40% of total billed charges,106.28,228.12,
OSMITROL/MANNITOL20%,6065130,CDM,636,RC,J2150,HCPCS,Outpatient,,,38.95,31.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.16,80,,24.93,percent of total billed charges,80% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% 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,15.58,40,,12.46,percent of total billed charges,40% of total billed charges,14.52,31.16,
PRAZOSIN 5MG CAP,6400014,CDM,250,RC,,,Outpatient,,,7.45,5.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.96,80,,4.77,percent of total billed charges,80% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% 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,2.98,40,,2.38,percent of total billed charges,40% of total billed charges,2.78,5.96,
POLYSPORIN POWDER,6400014,CDM,250,RC,,,Outpatient,,,36.99,29.59,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.59,80,,23.67,percent of total billed charges,80% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% 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,14.8,40,,11.84,percent of total billed charges,40% of total billed charges,13.79,29.59,
ATROPINE 0.25MG SYR,6065130,CDM,636,RC,J0461,HCPCS,Outpatient,,,100.85,80.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.68,80,,64.54,percent of total billed charges,80% of total billed charges,37.59,37.27,,30.07,percent of total billed charges,37.27% of total billed charges,37.59,37.27,,30.07,percent of total billed charges,37.27% of total billed charges,37.59,37.27,,30.07,percent of total billed charges,37.27% 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,40.34,40,,32.27,percent of total billed charges,40% of total billed charges,37.59,80.68,
ELTA CREME,5880901,CDM,637,RC,,,Outpatient,,,18.17,14.54,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.54,80,,11.63,percent of total billed charges,80% of total billed charges,6.77,37.27,,5.42,percent of total billed charges,37.27% of total billed charges,6.77,37.27,,5.42,percent of total billed charges,37.27% of total billed charges,6.77,37.27,,5.42,percent of total billed charges,37.27% 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,7.27,40,,5.82,percent of total billed charges,40% of total billed charges,6.77,14.54,
TDAP (ADACEL),6065130,CDM,636,RC,90715,HCPCS,Outpatient,,,172.8,138.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.24,80,,110.59,percent of total billed charges,80% of total billed charges,64.4,37.27,,51.52,percent of total billed charges,37.27% of total billed charges,64.4,37.27,,51.52,percent of total billed charges,37.27% of total billed charges,64.4,37.27,,51.52,percent of total billed charges,37.27% 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,69.12,40,,55.3,percent of total billed charges,40% of total billed charges,64.4,138.24,
ERAXIS 100MG IV VIAL,6400014,CDM,250,RC,,,Outpatient,,,736.55,589.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,589.24,80,,471.39,percent of total billed charges,80% of total billed charges,274.51,37.27,,219.61,percent of total billed charges,37.27% of total billed charges,274.51,37.27,,219.61,percent of total billed charges,37.27% of total billed charges,274.51,37.27,,219.61,percent of total billed charges,37.27% 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,294.62,40,,235.7,percent of total billed charges,40% of total billed charges,274.51,589.24,
HEPARIN 100UN/ML 5ML,6065130,CDM,636,RC,J1642,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
CEPHALEXIN 125/5ML,5880901,CDM,637,RC,,,Outpatient,,,85.5,68.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.4,80,,54.72,percent of total billed charges,80% of total billed charges,31.87,37.27,,25.5,percent of total billed charges,37.27% of total billed charges,31.87,37.27,,25.5,percent of total billed charges,37.27% of total billed charges,31.87,37.27,,25.5,percent of total billed charges,37.27% 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,34.2,40,,27.36,percent of total billed charges,40% of total billed charges,31.87,68.4,
FOLIC ACID 400MCG TB,5880901,CDM,637,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
GLUCERNA 1.5CAL,6400014,CDM,250,RC,,,Outpatient,,,18.35,14.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.68,80,,11.74,percent of total billed charges,80% of total billed charges,6.84,37.27,,5.47,percent of total billed charges,37.27% of total billed charges,6.84,37.27,,5.47,percent of total billed charges,37.27% of total billed charges,6.84,37.27,,5.47,percent of total billed charges,37.27% 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,7.34,40,,5.87,percent of total billed charges,40% of total billed charges,6.84,14.68,
CRIXIVAN 400MG CAP,6400014,CDM,250,RC,,,Outpatient,,,10.35,8.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.28,80,,6.62,percent of total billed charges,80% of total billed charges,3.86,37.27,,3.09,percent of total billed charges,37.27% of total billed charges,3.86,37.27,,3.09,percent of total billed charges,37.27% of total billed charges,3.86,37.27,,3.09,percent of total billed charges,37.27% 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,4.14,40,,3.31,percent of total billed charges,40% of total billed charges,3.86,8.28,
ZIDOVUDINE 100MG CAP,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
EPIVIR-HBV 100MG TAB,5880901,CDM,637,RC,,,Outpatient,,,66.5,53.20,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.2,80,,42.56,percent of total billed charges,80% of total billed charges,24.78,37.27,,19.82,percent of total billed charges,37.27% of total billed charges,24.78,37.27,,19.82,percent of total billed charges,37.27% of total billed charges,24.78,37.27,,19.82,percent of total billed charges,37.27% 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,26.6,40,,21.28,percent of total billed charges,40% of total billed charges,24.78,53.2,
ULORIC 80MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,35.25,28.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.2,80,,22.56,percent of total billed charges,80% of total billed charges,13.14,37.27,,10.51,percent of total billed charges,37.27% of total billed charges,13.14,37.27,,10.51,percent of total billed charges,37.27% of total billed charges,13.14,37.27,,10.51,percent of total billed charges,37.27% 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,14.1,40,,11.28,percent of total billed charges,40% of total billed charges,13.14,28.2,
RABIES IMMUNE GLOB,6065130,CDM,636,RC,90375,HCPCS,Outpatient,,,2963.65,2370.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2370.92,80,,1896.74,percent of total billed charges,80% of total billed charges,1104.55,37.27,,883.64,percent of total billed charges,37.27% of total billed charges,1104.55,37.27,,883.64,percent of total billed charges,37.27% of total billed charges,1104.55,37.27,,883.64,percent of total billed charges,37.27% of total billed charges,287.7,100,,,fee schedule,100% of APC rate,287.7,100,,,fee schedule,100% of APC rate,287.7,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,287.7,100,,,fee schedule,100% of APC rate,287.7,100,,,fee schedule,100% of APC rate,287.7,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1185.46,40,,948.37,percent of total billed charges,40% of total billed charges,287.7,2370.92,
JEVITY 1.5CAL,5880901,CDM,637,RC,,,Outpatient,,,5.65,4.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.52,80,,3.62,percent of total billed charges,80% of total billed charges,2.11,37.27,,1.69,percent of total billed charges,37.27% of total billed charges,2.11,37.27,,1.69,percent of total billed charges,37.27% of total billed charges,2.11,37.27,,1.69,percent of total billed charges,37.27% 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,2.26,40,,1.81,percent of total billed charges,40% of total billed charges,2.11,4.52,
DEXTROSE 50% 50ML VL,6400014,CDM,250,RC,,,Outpatient,,,17.6,14.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.08,80,,11.26,percent of total billed charges,80% of total billed charges,6.56,37.27,,5.25,percent of total billed charges,37.27% of total billed charges,6.56,37.27,,5.25,percent of total billed charges,37.27% of total billed charges,6.56,37.27,,5.25,percent of total billed charges,37.27% 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,7.04,40,,5.63,percent of total billed charges,40% of total billed charges,6.56,14.08,
EXCEDRIN PM,5880901,CDM,637,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
ATIVAN GEL 1MG/ML,6400014,CDM,250,RC,,,Outpatient,,,0.28,0.22,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.22,80,,0.18,percent of total billed charges,80% of total billed charges,0.1,37.27,,0.08,percent of total billed charges,37.27% of total billed charges,0.1,37.27,,0.08,percent of total billed charges,37.27% of total billed charges,0.1,37.27,,0.08,percent of total billed charges,37.27% 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,0.11,40,,0.09,percent of total billed charges,40% of total billed charges,0.1,0.22,
STERILE WATER F/INJ,6400014,CDM,250,RC,,,Outpatient,,,15.2,12.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.16,80,,9.73,percent of total billed charges,80% of total billed charges,5.67,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.67,37.27,,4.54,percent of total billed charges,37.27% of total billed charges,5.67,37.27,,4.54,percent of total billed charges,37.27% 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,6.08,40,,4.86,percent of total billed charges,40% of total billed charges,5.67,12.16,
D5W 500ML LATEX FREE,5753355,CDM,258,RC,J7070,HCPCS,Outpatient,,,5,4.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
K-PHOS ORIG TAB,5880901,CDM,637,RC,,,Outpatient,,,2.15,1.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.72,80,,1.38,percent of total billed charges,80% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% of total billed charges,0.8,37.27,,0.64,percent of total billed charges,37.27% 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,0.86,40,,0.69,percent of total billed charges,40% of total billed charges,0.8,1.72,
MORPHINE 2MG INJ,6065130,CDM,636,RC,J2270,HCPCS,Outpatient,,,13.1,10.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.48,80,,8.38,percent of total billed charges,80% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% 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,5.24,40,,4.19,percent of total billed charges,40% of total billed charges,4.88,10.48,
NUVIGIL 50MG,6400014,CDM,250,RC,,,Outpatient,,,48.4,38.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.72,80,,30.98,percent of total billed charges,80% of total billed charges,18.04,37.27,,14.43,percent of total billed charges,37.27% of total billed charges,18.04,37.27,,14.43,percent of total billed charges,37.27% of total billed charges,18.04,37.27,,14.43,percent of total billed charges,37.27% 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,19.36,40,,15.49,percent of total billed charges,40% of total billed charges,18.04,38.72,
VOLTAREN GEL 100GM,6400014,CDM,250,RC,,,Outpatient,,,104.02,83.22,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.22,80,,66.58,percent of total billed charges,80% of total billed charges,38.77,37.27,,31.02,percent of total billed charges,37.27% of total billed charges,38.77,37.27,,31.02,percent of total billed charges,37.27% of total billed charges,38.77,37.27,,31.02,percent of total billed charges,37.27% 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,41.61,40,,33.29,percent of total billed charges,40% of total billed charges,38.77,83.22,
ONGLYZA 5MG,6400014,CDM,250,RC,,,Outpatient,,,52.5,42.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42,80,,33.6,percent of total billed charges,80% of total billed charges,19.57,37.27,,15.66,percent of total billed charges,37.27% of total billed charges,19.57,37.27,,15.66,percent of total billed charges,37.27% of total billed charges,19.57,37.27,,15.66,percent of total billed charges,37.27% 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,21,40,,16.8,percent of total billed charges,40% of total billed charges,19.57,42,
NM CARDIO STRESS MS,6001655,CDM,341,RC,78452,HCPCS,Outpatient,,,3200,2560.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2560,80,,2048,percent of total billed charges,80% of total billed charges,1192.64,37.27,,954.11,percent of total billed charges,37.27% of total billed charges,1192.64,37.27,,954.11,percent of total billed charges,37.27% of total billed charges,1192.64,37.27,,954.11,percent of total billed charges,37.27% of total billed charges,1170.77,100,,,fee schedule,100% of APC rate,1170.77,100,,,fee schedule,100% of APC rate,1170.77,100,,,fee schedule,100% of APC rate,455.98,145,,,fee schedule,145% of CMS fee schedule,1170.77,100,,,fee schedule,100% of APC rate,1170.77,100,,,fee schedule,100% of APC rate,1170.77,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1280,40,,1024,percent of total billed charges,40% of total billed charges,455.98,2560,
NTG 25MG/250ML,6065130,CDM,636,RC,J2305,HCPCS,Outpatient,,,67.05,53.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.64,80,,42.91,percent of total billed charges,80% of total billed charges,24.99,37.27,,19.99,percent of total billed charges,37.27% of total billed charges,24.99,37.27,,19.99,percent of total billed charges,37.27% of total billed charges,24.99,37.27,,19.99,percent of total billed charges,37.27% of total billed charges,1.41,100,,,fee schedule,100% of APC rate,1.41,100,,,fee schedule,100% of APC rate,1.41,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1.41,100,,,fee schedule,100% of APC rate,1.41,100,,,fee schedule,100% of APC rate,1.41,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.82,40,,21.46,percent of total billed charges,40% of total billed charges,1.41,53.64,
COMBIGAN OPTH SOLN,5880901,CDM,637,RC,,,Outpatient,,,712.85,570.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,570.28,80,,456.22,percent of total billed charges,80% of total billed charges,265.68,37.27,,212.54,percent of total billed charges,37.27% of total billed charges,265.68,37.27,,212.54,percent of total billed charges,37.27% of total billed charges,265.68,37.27,,212.54,percent of total billed charges,37.27% 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,285.14,40,,228.11,percent of total billed charges,40% of total billed charges,265.68,570.28,
HEMORRHOIDAL OINT,5880901,CDM,637,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
GLUCERNA 1.2 CAL,6400014,CDM,250,RC,,,Outpatient,,,16.4,13.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.12,80,,10.5,percent of total billed charges,80% of total billed charges,6.11,37.27,,4.89,percent of total billed charges,37.27% of total billed charges,6.11,37.27,,4.89,percent of total billed charges,37.27% of total billed charges,6.11,37.27,,4.89,percent of total billed charges,37.27% 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,6.56,40,,5.25,percent of total billed charges,40% of total billed charges,6.11,13.12,
LUPRON DEPOT 30MG,6065130,CDM,636,RC,J9217,HCPCS,Outpatient,,,2608.02,2086.42,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2086.42,80,,1669.14,percent of total billed charges,80% of total billed charges,972.01,37.27,,777.61,percent of total billed charges,37.27% of total billed charges,972.01,37.27,,777.61,percent of total billed charges,37.27% of total billed charges,972.01,37.27,,777.61,percent of total billed charges,37.27% of total billed charges,176.51,100,,,fee schedule,100% of APC rate,176.51,100,,,fee schedule,100% of APC rate,176.51,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,176.51,100,,,fee schedule,100% of APC rate,176.51,100,,,fee schedule,100% of APC rate,176.51,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1043.21,40,,834.57,percent of total billed charges,40% of total billed charges,176.51,2086.42,
DDAVP NASAL SPRAY,5880901,CDM,637,RC,,,Outpatient,,,642.75,514.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,514.2,80,,411.36,percent of total billed charges,80% of total billed charges,239.55,37.27,,191.64,percent of total billed charges,37.27% of total billed charges,239.55,37.27,,191.64,percent of total billed charges,37.27% of total billed charges,239.55,37.27,,191.64,percent of total billed charges,37.27% 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,257.1,40,,205.68,percent of total billed charges,40% of total billed charges,239.55,514.2,
CT NECK SFT TIS WO/W,6010052,CDM,350,RC,70492,HCPCS,Outpatient,,,2399,1919.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1919.2,80,,1535.36,percent of total billed charges,80% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,192.21,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,959.6,40,,767.68,percent of total billed charges,40% of total billed charges,151.49,1919.2,
NAPRELAN 500MG TAB,6400014,CDM,250,RC,,,Outpatient,,,81.65,65.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.32,80,,52.26,percent of total billed charges,80% of total billed charges,30.43,37.27,,24.34,percent of total billed charges,37.27% of total billed charges,30.43,37.27,,24.34,percent of total billed charges,37.27% of total billed charges,30.43,37.27,,24.34,percent of total billed charges,37.27% 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,32.66,40,,26.13,percent of total billed charges,40% of total billed charges,30.43,65.32,
PREMARIN 25MG INJ,6400014,CDM,250,RC,J1410,HCPCS,Outpatient,,,663,530.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,530.4,80,,424.32,percent of total billed charges,80% of total billed charges,247.1,37.27,,197.68,percent of total billed charges,37.27% of total billed charges,247.1,37.27,,197.68,percent of total billed charges,37.27% of total billed charges,247.1,37.27,,197.68,percent of total billed charges,37.27% of total billed charges,382.79,100,,,fee schedule,100% of APC rate,382.79,100,,,fee schedule,100% of APC rate,382.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,382.79,100,,,fee schedule,100% of APC rate,382.79,100,,,fee schedule,100% of APC rate,382.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,265.2,40,,212.16,percent of total billed charges,40% of total billed charges,247.1,530.4,
HUMALOG MIX 50/50 IN,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,99.7,79.76,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.76,80,,63.81,percent of total billed charges,80% of total billed charges,37.16,37.27,,29.73,percent of total billed charges,37.27% of total billed charges,37.16,37.27,,29.73,percent of total billed charges,37.27% of total billed charges,37.16,37.27,,29.73,percent of total billed charges,37.27% 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,39.88,40,,31.9,percent of total billed charges,40% of total billed charges,37.16,79.76,
GUAIFENESIN 200MG,5880901,CDM,637,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CHANTIX 0.5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,6.8,5.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.44,80,,4.35,percent of total billed charges,80% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% of total billed charges,2.53,37.27,,2.02,percent of total billed charges,37.27% 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,2.72,40,,2.18,percent of total billed charges,40% of total billed charges,2.53,5.44,
LEVOPHED 1MG/ML INJ,6400014,CDM,250,RC,,,Outpatient,,,18.8,15.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.04,80,,12.03,percent of total billed charges,80% of total billed charges,7.01,37.27,,5.61,percent of total billed charges,37.27% of total billed charges,7.01,37.27,,5.61,percent of total billed charges,37.27% of total billed charges,7.01,37.27,,5.61,percent of total billed charges,37.27% 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,7.52,40,,6.02,percent of total billed charges,40% of total billed charges,7.01,15.04,
ASTRAMORPH 2MG/ML,6400014,CDM,250,RC,,,Outpatient,,,37.1,29.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.68,80,,23.74,percent of total billed charges,80% of total billed charges,13.83,37.27,,11.06,percent of total billed charges,37.27% of total billed charges,13.83,37.27,,11.06,percent of total billed charges,37.27% of total billed charges,13.83,37.27,,11.06,percent of total billed charges,37.27% 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,14.84,40,,11.87,percent of total billed charges,40% of total billed charges,13.83,29.68,
MORPHINE 15MG VIAL,6400014,CDM,250,RC,J2270,HCPCS,Outpatient,,,13.1,10.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.48,80,,8.38,percent of total billed charges,80% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% 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,5.24,40,,4.19,percent of total billed charges,40% of total billed charges,4.88,10.48,
CIPROFLOXACIN OPTH,5880901,CDM,637,RC,,,Outpatient,,,85.35,68.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.28,80,,54.62,percent of total billed charges,80% of total billed charges,31.81,37.27,,25.45,percent of total billed charges,37.27% of total billed charges,31.81,37.27,,25.45,percent of total billed charges,37.27% of total billed charges,31.81,37.27,,25.45,percent of total billed charges,37.27% 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,34.14,40,,27.31,percent of total billed charges,40% of total billed charges,31.81,68.28,
VISINE A,6400014,CDM,250,RC,,,Outpatient,,,19.85,15.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.88,80,,12.7,percent of total billed charges,80% of total billed charges,7.4,37.27,,5.92,percent of total billed charges,37.27% of total billed charges,7.4,37.27,,5.92,percent of total billed charges,37.27% of total billed charges,7.4,37.27,,5.92,percent of total billed charges,37.27% 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,7.94,40,,6.35,percent of total billed charges,40% of total billed charges,7.4,15.88,
CALCITRIOL 1MCG/ML,6065130,CDM,636,RC,J0636,HCPCS,Outpatient,,,4.09,3.27,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.27,80,,2.62,percent of total billed charges,80% of total billed charges,1.52,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.52,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.52,37.27,,1.22,percent of total billed charges,37.27% 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,1.64,40,,1.31,percent of total billed charges,40% of total billed charges,1.52,3.27,
HEPARIN FLUSH SYRING,6065130,CDM,636,RC,J1642,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
VITAMIN D3 1000 UNIT,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
FER IN SOL INFANT DP,5880901,CDM,637,RC,,,Outpatient,,,7.05,5.64,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.64,80,,4.51,percent of total billed charges,80% of total billed charges,2.63,37.27,,2.1,percent of total billed charges,37.27% of total billed charges,2.63,37.27,,2.1,percent of total billed charges,37.27% of total billed charges,2.63,37.27,,2.1,percent of total billed charges,37.27% 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,2.82,40,,2.26,percent of total billed charges,40% of total billed charges,2.63,5.64,
FERROUS SULFATE DROP,5880901,CDM,637,RC,,,Outpatient,,,15.7,12.56,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.56,80,,10.05,percent of total billed charges,80% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% of total billed charges,5.85,37.27,,4.68,percent of total billed charges,37.27% 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,6.28,40,,5.02,percent of total billed charges,40% of total billed charges,5.85,12.56,
NOREL SR TAB,6400014,CDM,250,RC,,,Outpatient,,,3.25,2.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.6,80,,2.08,percent of total billed charges,80% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% 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,1.3,40,,1.04,percent of total billed charges,40% of total billed charges,1.21,2.6,
METFORMIN XR 750MG,6400014,CDM,250,RC,,,Outpatient,,,3.65,2.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.92,80,,2.34,percent of total billed charges,80% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% of total billed charges,1.36,37.27,,1.09,percent of total billed charges,37.27% 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,1.46,40,,1.17,percent of total billed charges,40% of total billed charges,1.36,2.92,
PAPVARINE HCL INJ,6400014,CDM,250,RC,,,Outpatient,,,4.09,3.27,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.27,80,,2.62,percent of total billed charges,80% of total billed charges,1.52,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.52,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.52,37.27,,1.22,percent of total billed charges,37.27% 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,1.64,40,,1.31,percent of total billed charges,40% of total billed charges,1.52,3.27,
CHILDRENS COLD/ALLER,5880901,CDM,637,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
CLINIMIX 4.25/25 TPN,6400014,CDM,250,RC,,,Outpatient,,,169.35,135.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.48,80,,108.38,percent of total billed charges,80% of total billed charges,63.12,37.27,,50.5,percent of total billed charges,37.27% of total billed charges,63.12,37.27,,50.5,percent of total billed charges,37.27% of total billed charges,63.12,37.27,,50.5,percent of total billed charges,37.27% 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,67.74,40,,54.19,percent of total billed charges,40% of total billed charges,63.12,135.48,
TIKOSYN 125MCG CAP,6400014,CDM,250,RC,,,Outpatient,,,19.4,15.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.52,80,,12.42,percent of total billed charges,80% of total billed charges,7.23,37.27,,5.78,percent of total billed charges,37.27% of total billed charges,7.23,37.27,,5.78,percent of total billed charges,37.27% of total billed charges,7.23,37.27,,5.78,percent of total billed charges,37.27% 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,7.76,40,,6.21,percent of total billed charges,40% of total billed charges,7.23,15.52,
CTA LOWER EXT W/WO,6010052,CDM,350,RC,73706,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,309.17,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,151.49,1316,
CTA NECK W/WO,6010052,CDM,350,RC,70498,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,255.35,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,151.49,1316,
CTA CHEST W/WO,6010052,CDM,350,RC,71275,HCPCS,Outpatient,,,2124,1699.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1699.2,80,,1359.36,percent of total billed charges,80% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,258.72,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,849.6,40,,679.68,percent of total billed charges,40% of total billed charges,151.49,1699.2,
CTA PELVIS W/WO,6010052,CDM,350,RC,72191,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,290.44,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,151.49,1316,
CTA UPPER EXT W/WO,6010052,CDM,350,RC,73206,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,280.71,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,151.49,1316,
MRI THORACIC SP W/CO,6220180,CDM,612,RC,72147,HCPCS,Outpatient,,,3290,2632.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2632,80,,2105.6,percent of total billed charges,80% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,250.69,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,40,,1052.8,percent of total billed charges,40% of total billed charges,250.69,2632,
CTA ABD WO/W,6010052,CDM,350,RC,74175,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,290.86,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,151.49,2412.8,
MRI LUMBAR SPINE W/C,6220180,CDM,612,RC,72149,HCPCS,Outpatient,,,3290,2632.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2632,80,,2105.6,percent of total billed charges,80% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,247.31,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,40,,1052.8,percent of total billed charges,40% of total billed charges,247.31,2632,
MRA UPPER EXT W OR W,6212047,CDM,610,RC,73225,HCPCS,Outpatient,,,3564,2851.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344.26,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,344.26,2851.2,
MRI ORB FACE NECKWWO,6212047,CDM,610,RC,70543,HCPCS,Outpatient,,,3564,2851.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,314.95,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,314.95,2851.2,
MRI UP EXT NOJOIN WO,6212047,CDM,610,RC,73218,HCPCS,Outpatient,,,3016,2412.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,315.81,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,202.03,2412.8,
MRI UPEXT NOJNT W/WO,6212047,CDM,610,RC,73220,HCPCS,Outpatient,,,3564,2851.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,407.55,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,317.08,2851.2,
MRI JOINT LOW EXW/WO,6212047,CDM,610,RC,73723,HCPCS,Outpatient,,,3564,2851.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,375.84,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,317.08,2851.2,
MRI JOINT LOWEXT W/O,6212047,CDM,610,RC,73721,HCPCS,Outpatient,,,3016,2412.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,183.76,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,183.76,2412.8,
MRI LOWEXT NOJT W/WO,6212047,CDM,610,RC,73720,HCPCS,Outpatient,,,3564,2851.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,312.84,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,312.84,2851.2,
MRI LOWEXT NOJOINTWO,6212047,CDM,610,RC,73718,HCPCS,Outpatient,,,3016,2412.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,211.66,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,202.03,2412.8,
MRI PELVIS W CONT,6212047,CDM,610,RC,72196,HCPCS,Outpatient,,,3290,2632.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2632,80,,2105.6,percent of total billed charges,80% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,248.15,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,40,,1052.8,percent of total billed charges,40% of total billed charges,248.15,2632,
MRI ORB FACE/NECK WO,6212047,CDM,610,RC,70540,HCPCS,Outpatient,,,3016,2412.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,215.47,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,202.03,2412.8,
INSERT FOLEYCATH OSS,5612346,CDM,761,RC,51702,HCPCS,Outpatient,,,136,108.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,35.47,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,35.47,108.8,
AMINOSYN 10%,6400014,CDM,250,RC,,,Outpatient,,,199,159.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% 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,79.6,40,,63.68,percent of total billed charges,40% of total billed charges,74.17,159.2,
CT FACIAL BONES WO,6010052,CDM,350,RC,70486,HCPCS,Outpatient,,,1645,1316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,115.97,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,90.64,1316,
METOCLOPRAMIDE 5 TAB,5880901,CDM,637,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
VAC ADMIN 1ST,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,27.36,128,
PRADAXA 150MG CAP,6400014,CDM,250,RC,,,Outpatient,,,8.3,6.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.64,80,,5.31,percent of total billed charges,80% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% of total billed charges,3.09,37.27,,2.47,percent of total billed charges,37.27% 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,3.32,40,,2.66,percent of total billed charges,40% of total billed charges,3.09,6.64,
CYTOVENE 500MG,6400014,CDM,250,RC,J1570,HCPCS,Outpatient,,,486.75,389.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,389.4,80,,311.52,percent of total billed charges,80% of total billed charges,181.41,37.27,,145.13,percent of total billed charges,37.27% of total billed charges,181.41,37.27,,145.13,percent of total billed charges,37.27% of total billed charges,181.41,37.27,,145.13,percent of total billed charges,37.27% 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,194.7,40,,155.76,percent of total billed charges,40% of total billed charges,181.41,389.4,
FF PLASMA PER UNIT,7051695,CDM,390,RC,P9017,HCPCS,Outpatient,,,286,228.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,79.95,100,,,fee schedule,100% of APC rate,79.95,100,,,fee schedule,100% of APC rate,79.95,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,79.95,100,,,fee schedule,100% of APC rate,79.95,100,,,fee schedule,100% of APC rate,79.95,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.4,40,,91.52,percent of total billed charges,40% of total billed charges,79.95,228.8,
PLATELETS PHERESIS I,7051695,CDM,390,RC,P9036,HCPCS,Outpatient,,,1343,1074.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1074.4,80,,859.52,percent of total billed charges,80% of total billed charges,500.54,37.27,,400.43,percent of total billed charges,37.27% of total billed charges,500.54,37.27,,400.43,percent of total billed charges,37.27% of total billed charges,500.54,37.27,,400.43,percent of total billed charges,37.27% of total billed charges,559.94,100,,,fee schedule,100% of APC rate,559.94,100,,,fee schedule,100% of APC rate,559.94,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,559.94,100,,,fee schedule,100% of APC rate,559.94,100,,,fee schedule,100% of APC rate,559.94,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,537.2,40,,429.76,percent of total billed charges,40% of total billed charges,500.54,1074.4,
PLATELETS IRR PER UN,7051695,CDM,390,RC,P9032,HCPCS,Outpatient,,,1239,991.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,991.2,80,,792.96,percent of total billed charges,80% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% of total billed charges,133.36,100,,,fee schedule,100% of APC rate,133.36,100,,,fee schedule,100% of APC rate,133.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,133.36,100,,,fee schedule,100% of APC rate,133.36,100,,,fee schedule,100% of APC rate,133.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,495.6,40,,396.48,percent of total billed charges,40% of total billed charges,133.36,991.2,
PLATELETS PHERESIS P,7051695,CDM,390,RC,P9034,HCPCS,Outpatient,,,1239,991.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,991.2,80,,792.96,percent of total billed charges,80% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% of total billed charges,321.86,100,,,fee schedule,100% of APC rate,321.86,100,,,fee schedule,100% of APC rate,321.86,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,321.86,100,,,fee schedule,100% of APC rate,321.86,100,,,fee schedule,100% of APC rate,321.86,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,495.6,40,,396.48,percent of total billed charges,40% of total billed charges,321.86,991.2,
RBC LEUKO REDUCED PE,7051695,CDM,390,RC,P9016,HCPCS,Outpatient,,,250,200.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200,80,,160,percent of total billed charges,80% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% of total billed charges,180.82,100,,,fee schedule,100% of APC rate,180.82,100,,,fee schedule,100% of APC rate,180.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,180.82,100,,,fee schedule,100% of APC rate,180.82,100,,,fee schedule,100% of APC rate,180.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100,40,,80,percent of total billed charges,40% of total billed charges,93.18,200,
PRAVASTATIN 20MG,6400014,CDM,250,RC,,,Outpatient,,,14.5,11.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.6,80,,9.28,percent of total billed charges,80% of total billed charges,5.4,37.27,,4.32,percent of total billed charges,37.27% of total billed charges,5.4,37.27,,4.32,percent of total billed charges,37.27% of total billed charges,5.4,37.27,,4.32,percent of total billed charges,37.27% 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,5.8,40,,4.64,percent of total billed charges,40% of total billed charges,5.4,11.6,
PRADAXA 75MG CAP,6400014,CDM,250,RC,,,Outpatient,,,27.3,21.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.84,80,,17.47,percent of total billed charges,80% of total billed charges,10.17,37.27,,8.14,percent of total billed charges,37.27% of total billed charges,10.17,37.27,,8.14,percent of total billed charges,37.27% of total billed charges,10.17,37.27,,8.14,percent of total billed charges,37.27% 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,10.92,40,,8.74,percent of total billed charges,40% of total billed charges,10.17,21.84,
AYR BABY DROPS,5880901,CDM,637,RC,,,Outpatient,,,13.4,10.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.72,80,,8.58,percent of total billed charges,80% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% of total billed charges,4.99,37.27,,3.99,percent of total billed charges,37.27% 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,5.36,40,,4.29,percent of total billed charges,40% of total billed charges,4.99,10.72,
"CREON 24,000UN",5880901,CDM,637,RC,,,Outpatient,,,33.65,26.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.92,80,,21.54,percent of total billed charges,80% of total billed charges,12.54,37.27,,10.03,percent of total billed charges,37.27% of total billed charges,12.54,37.27,,10.03,percent of total billed charges,37.27% of total billed charges,12.54,37.27,,10.03,percent of total billed charges,37.27% 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,13.46,40,,10.77,percent of total billed charges,40% of total billed charges,12.54,26.92,
DURAMORPH 1MG/ML 10M,6400014,CDM,250,RC,,,Outpatient,,,115,92.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% 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,46,40,,36.8,percent of total billed charges,40% of total billed charges,42.86,92,
SANTYL 15GM,6400014,CDM,250,RC,,,Outpatient,,,1055.8,844.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,844.64,80,,675.71,percent of total billed charges,80% of total billed charges,393.5,37.27,,314.8,percent of total billed charges,37.27% of total billed charges,393.5,37.27,,314.8,percent of total billed charges,37.27% of total billed charges,393.5,37.27,,314.8,percent of total billed charges,37.27% 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,422.32,40,,337.86,percent of total billed charges,40% of total billed charges,393.5,844.64,
ALPHAGAN P 0.1% OPT.,6400014,CDM,250,RC,,,Outpatient,,,327.35,261.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,261.88,80,,209.5,percent of total billed charges,80% of total billed charges,122,37.27,,97.6,percent of total billed charges,37.27% of total billed charges,122,37.27,,97.6,percent of total billed charges,37.27% of total billed charges,122,37.27,,97.6,percent of total billed charges,37.27% 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,130.94,40,,104.75,percent of total billed charges,40% of total billed charges,122,261.88,
NEVANAC 0.1% OPTHALM,6400014,CDM,250,RC,,,Outpatient,,,430.05,344.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344.04,80,,275.23,percent of total billed charges,80% of total billed charges,160.28,37.27,,128.22,percent of total billed charges,37.27% of total billed charges,160.28,37.27,,128.22,percent of total billed charges,37.27% of total billed charges,160.28,37.27,,128.22,percent of total billed charges,37.27% 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,172.02,40,,137.62,percent of total billed charges,40% of total billed charges,160.28,344.04,
AXILECT 0.5MG TAB,6400014,CDM,250,RC,A9270,HCPCS,Outpatient,,,132.65,106.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.12,80,,84.9,percent of total billed charges,80% of total billed charges,49.44,37.27,,39.55,percent of total billed charges,37.27% of total billed charges,49.44,37.27,,39.55,percent of total billed charges,37.27% of total billed charges,49.44,37.27,,39.55,percent of total billed charges,37.27% 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,53.06,40,,42.45,percent of total billed charges,40% of total billed charges,49.44,106.12,
SAPHRIS 5MG SL TAB,6400014,CDM,250,RC,,,Outpatient,,,47,37.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.6,80,,30.08,percent of total billed charges,80% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% of total billed charges,17.52,37.27,,14.02,percent of total billed charges,37.27% 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,18.8,40,,15.04,percent of total billed charges,40% of total billed charges,17.52,37.6,
DXA BONE DENSITY RTN,6000392,CDM,320,RC,77080,HCPCS,Outpatient,,,287,229.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,106.96,37.27,,85.57,percent of total billed charges,37.27% of total billed charges,106.96,37.27,,85.57,percent of total billed charges,37.27% of total billed charges,106.96,37.27,,85.57,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,37.76,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.8,40,,91.84,percent of total billed charges,40% of total billed charges,37.76,229.6,
FOOT 3 VIEW,6000392,CDM,320,RC,73630,HCPCS,Outpatient,,,315,252.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252,80,,201.6,percent of total billed charges,80% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,33.52,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126,40,,100.8,percent of total billed charges,40% of total billed charges,33.52,252,
NACL 10% INHAL.SOLN.,6400014,CDM,250,RC,,,Outpatient,,,4.75,3.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.8,80,,3.04,percent of total billed charges,80% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% 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,1.9,40,,1.52,percent of total billed charges,40% of total billed charges,1.77,3.8,
SAPHRIS 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,51.65,41.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.32,80,,33.06,percent of total billed charges,80% of total billed charges,19.25,37.27,,15.4,percent of total billed charges,37.27% of total billed charges,19.25,37.27,,15.4,percent of total billed charges,37.27% of total billed charges,19.25,37.27,,15.4,percent of total billed charges,37.27% 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,20.66,40,,16.53,percent of total billed charges,40% of total billed charges,19.25,41.32,
HYDROXYZINE HCL 5ML,6400014,CDM,250,RC,,,Outpatient,,,7.05,5.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.64,80,,4.51,percent of total billed charges,80% of total billed charges,2.63,37.27,,2.1,percent of total billed charges,37.27% of total billed charges,2.63,37.27,,2.1,percent of total billed charges,37.27% of total billed charges,2.63,37.27,,2.1,percent of total billed charges,37.27% 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,2.82,40,,2.26,percent of total billed charges,40% of total billed charges,2.63,5.64,
PERFOROMIST INH TXT`,6065130,CDM,636,RC,J7606,HCPCS,Outpatient,,,46.45,37.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.16,80,,29.73,percent of total billed charges,80% of total billed charges,17.31,37.27,,13.85,percent of total billed charges,37.27% of total billed charges,17.31,37.27,,13.85,percent of total billed charges,37.27% of total billed charges,17.31,37.27,,13.85,percent of total billed charges,37.27% 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,18.58,40,,14.86,percent of total billed charges,40% of total billed charges,17.31,37.16,
PROMETH VC/COD 5ML,6400014,CDM,250,RC,,,Outpatient,,,9.3,7.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.44,80,,5.95,percent of total billed charges,80% of total billed charges,3.47,37.27,,2.78,percent of total billed charges,37.27% of total billed charges,3.47,37.27,,2.78,percent of total billed charges,37.27% of total billed charges,3.47,37.27,,2.78,percent of total billed charges,37.27% 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,3.72,40,,2.98,percent of total billed charges,40% of total billed charges,3.47,7.44,
DECONEX IR,6400014,CDM,250,RC,,,Outpatient,,,2.5,2.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
IV HYDR INITIAL,5811182,CDM,260,RC,96360,HCPCS,Outpatient,,,222,177.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,42.15,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,40,,71.04,percent of total billed charges,40% of total billed charges,42.15,177.6,
IV HYDR EA ADDL,5811182,CDM,260,RC,96361,HCPCS,Outpatient,,,77,61.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,16.3,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,16.3,61.6,
IV INF THERAPY INT,5811182,CDM,260,RC,96365,HCPCS,Outpatient,,,526,420.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.8,80,,336.64,percent of total billed charges,80% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,81.26,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,40,,168.32,percent of total billed charges,40% of total billed charges,81.26,420.8,
IV INF THER ADD HRS,5811182,CDM,260,RC,96366,HCPCS,Outpatient,,,123,98.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,26.98,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,40,,39.36,percent of total billed charges,40% of total billed charges,26.98,98.4,
IV PUSH INITIAL,5811182,CDM,260,RC,96374,HCPCS,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,47.84,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198,40,,158.4,percent of total billed charges,40% of total billed charges,47.84,396,
IV PUSH EA ADDL NEW,5811182,CDM,260,RC,96375,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,20.17,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,40,,35.2,percent of total billed charges,40% of total billed charges,20.17,88,
IV PUSH EA ADDL SAME,5811182,CDM,260,RC,96376,HCPCS,Outpatient,,,108,86.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% 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,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,40.25,86.4,
INJECTION SUBC OR IM,5811182,CDM,260,RC,96372,HCPCS,Outpatient,,,77,61.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,19.31,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,19.31,61.6,
OB BLOOD TRANSFUSION,5811120,CDM,391,RC,36430,HCPCS,Outpatient,,,1034,827.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,827.2,80,,661.76,percent of total billed charges,80% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,54.09,145,,,fee schedule,145% of CMS fee schedule,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413.6,40,,330.88,percent of total billed charges,40% of total billed charges,54.09,827.2,
CURRETAGE,,,720,RC,58356,HCPCS,Outpatient,,,9209,7367.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7367.2,80,,5893.76,percent of total billed charges,80% of total billed charges,3432.19,37.27,,2745.75,percent of total billed charges,37.27% of total billed charges,3432.19,37.27,,2745.75,percent of total billed charges,37.27% of total billed charges,3432.19,37.27,,2745.75,percent of total billed charges,37.27% of total billed charges,4101.02,100,,,fee schedule,100% of APC rate,4101.02,100,,,fee schedule,100% of APC rate,4101.02,100,,,fee schedule,100% of APC rate,502.05,145,,,fee schedule,145% of CMS fee schedule,4101.02,100,,,fee schedule,100% of APC rate,4101.02,100,,,fee schedule,100% of APC rate,4101.02,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3683.6,40,,2946.88,percent of total billed charges,40% of total billed charges,502.05,7367.2,
US PREG UTERUS LIMTD,6000566,CDM,402,RC,76815,HCPCS,Outpatient,,,565,452.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,452,80,,361.6,percent of total billed charges,80% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,64.39,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226,40,,180.8,percent of total billed charges,40% of total billed charges,64.39,452,
US TRANSVAGINAL,6000566,CDM,402,RC,76817,HCPCS,Outpatient,,,565,452.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,452,80,,361.6,percent of total billed charges,80% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,72.85,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226,40,,180.8,percent of total billed charges,40% of total billed charges,72.85,452,
US TRANSABDO>=14 WKS,6000566,CDM,402,RC,76805,HCPCS,Outpatient,,,565,452.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,452,80,,361.6,percent of total billed charges,80% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,113.14,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226,40,,180.8,percent of total billed charges,40% of total billed charges,90.64,452,
AMNIOINFUSION,,,720,RC,59070,HCPCS,Outpatient,,,332,265.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,265.6,80,,212.48,percent of total billed charges,80% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% of total billed charges,264.5,100,,,fee schedule,100% of APC rate,264.5,100,,,fee schedule,100% of APC rate,264.5,100,,,fee schedule,100% of APC rate,443.58,145,,,fee schedule,145% of CMS fee schedule,264.5,100,,,fee schedule,100% of APC rate,264.5,100,,,fee schedule,100% of APC rate,264.5,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.8,40,,106.24,percent of total billed charges,40% of total billed charges,123.74,443.58,
IV HYDR INITIAL,5811182,CDM,260,RC,96360,HCPCS,Outpatient,,,222,177.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,42.15,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,40,,71.04,percent of total billed charges,40% of total billed charges,42.15,177.6,
IV HYDR EA ADDL,5811182,CDM,260,RC,96361,HCPCS,Outpatient,,,77,61.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,16.3,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,16.3,61.6,
IV INF THERAPY INT,5811182,CDM,260,RC,96365,HCPCS,Outpatient,,,526,420.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.8,80,,336.64,percent of total billed charges,80% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,81.26,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,40,,168.32,percent of total billed charges,40% of total billed charges,81.26,420.8,
IV INF THER ADD HRS,5811182,CDM,260,RC,96366,HCPCS,Outpatient,,,123,98.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,26.98,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,40,,39.36,percent of total billed charges,40% of total billed charges,26.98,98.4,
IV INFUSION SEQ 1 HR,5811182,CDM,260,RC,96367,HCPCS,Outpatient,,,134,107.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,37.19,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,40,,42.88,percent of total billed charges,40% of total billed charges,37.19,107.2,
IV INFUSION CONCUR,5811182,CDM,260,RC,96368,HCPCS,Outpatient,,,146,116.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.09,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,26.09,116.8,
CT ABD + PELV WO/W,6010052,CDM,350,RC,74178,HCPCS,Outpatient,,,3564,2851.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,324.68,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,317.08,2851.2,
WHISPER ADAPTER,5645742,CDM,270,RC,,,Outpatient,,,102,81.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% 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,40.8,40,,32.64,percent of total billed charges,40% of total billed charges,38.02,81.6,
CPAP/BIPAP MASK,5645742,CDM,270,RC,,,Outpatient,,,67,53.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% 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,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,24.97,53.6,
MIST TENT CANOPY,5645742,CDM,270,RC,,,Outpatient,,,75,60.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,80,,48,percent of total billed charges,80% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% 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,30,40,,24,percent of total billed charges,40% of total billed charges,27.95,60,
SERVO-I FILTER,5645742,CDM,270,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
AC JOINTS 2VWS W/WO,6000392,CDM,320,RC,73050,HCPCS,Outpatient,,,300,240.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,25.49,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,25.49,240,
PULSE OX MULTI RESP,7441215,CDM,460,RC,94761,HCPCS,Outpatient,,,149,119.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.19,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.6,40,,47.68,percent of total billed charges,40% of total billed charges,5.19,119.2,
CT AB + PELV W,6010052,CDM,350,RC,74177,HCPCS,Outpatient,,,3290,2632.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2632,80,,2105.6,percent of total billed charges,80% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,1226.18,37.27,,980.94,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,287.35,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,40,,1052.8,percent of total billed charges,40% of total billed charges,287.35,2632,
CT ABD + PELV WO,6010052,CDM,350,RC,74176,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,135.13,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,135.13,2412.8,
ANTI-IGE RECEPTOR AB,7039034,CDM,311,RC,,,Outpatient,,,558.86,447.09,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,447.09,80,,357.67,percent of total billed charges,80% of total billed charges,208.29,37.27,,166.63,percent of total billed charges,37.27% of total billed charges,208.29,37.27,,166.63,percent of total billed charges,37.27% of total billed charges,208.29,37.27,,166.63,percent of total billed charges,37.27% 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,223.54,40,,178.83,percent of total billed charges,40% of total billed charges,208.29,447.09,
FLOW CYTOMETRY 1ST M,7000177,CDM,305,RC,88184,HCPCS,Outpatient,,,430.86,344.69,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344.69,80,,275.75,percent of total billed charges,80% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,99.19,145,,,fee schedule,145% of CMS fee schedule,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.34,40,,137.87,percent of total billed charges,40% of total billed charges,99.19,344.69,
FLOW CYTOMETRY EA AD,7000177,CDM,305,RC,88185,HCPCS,Outpatient,,,64,51.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.02,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,23.85,51.2,
ANTI-EXT NUC AGS PN,7000169,CDM,302,RC,,,Outpatient,,,128,102.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,47.71,37.27,,38.17,percent of total billed charges,37.27% of total billed charges,47.71,37.27,,38.17,percent of total billed charges,37.27% of total billed charges,47.71,37.27,,38.17,percent of total billed charges,37.27% 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,51.2,40,,40.96,percent of total billed charges,40% of total billed charges,47.71,102.4,
TESTOST F&WEAK PANEL,7000029,CDM,301,RC,,,Outpatient,,,287,229.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.6,80,,183.68,percent of total billed charges,80% of total billed charges,106.96,37.27,,85.57,percent of total billed charges,37.27% of total billed charges,106.96,37.27,,85.57,percent of total billed charges,37.27% of total billed charges,106.96,37.27,,85.57,percent of total billed charges,37.27% 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,114.8,40,,91.84,percent of total billed charges,40% of total billed charges,106.96,229.6,
TYPHUS FEVER PANEL,7000029,CDM,301,RC,,,Outpatient,,,76,60.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% 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,30.4,40,,24.32,percent of total billed charges,40% of total billed charges,28.33,60.8,
ERBE LFT PROBE W/SYR,5645742,CDM,270,RC,,,Outpatient,,,139,111.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,51.81,37.27,,41.45,percent of total billed charges,37.27% of total billed charges,51.81,37.27,,41.45,percent of total billed charges,37.27% of total billed charges,51.81,37.27,,41.45,percent of total billed charges,37.27% 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,55.6,40,,44.48,percent of total billed charges,40% of total billed charges,51.81,111.2,
PORT MAINT/FLUSH,8400010,CDM,760,RC,96523,HCPCS,Outpatient,,,128,102.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,47.71,37.27,,38.17,percent of total billed charges,37.27% of total billed charges,47.71,37.27,,38.17,percent of total billed charges,37.27% of total billed charges,47.71,37.27,,38.17,percent of total billed charges,37.27% of total billed charges,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,32.07,145,,,fee schedule,145% of CMS fee schedule,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,40,,40.96,percent of total billed charges,40% of total billed charges,32.07,102.4,
REMOVE PICC/CNTRL LI,8400010,CDM,760,RC,36589,HCPCS,Outpatient,,,1285,1028.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1028,80,,822.4,percent of total billed charges,80% of total billed charges,478.92,37.27,,383.14,percent of total billed charges,37.27% of total billed charges,478.92,37.27,,383.14,percent of total billed charges,37.27% of total billed charges,478.92,37.27,,383.14,percent of total billed charges,37.27% of total billed charges,517.96,100,,,fee schedule,100% of APC rate,517.96,100,,,fee schedule,100% of APC rate,517.96,100,,,fee schedule,100% of APC rate,188.43,145,,,fee schedule,145% of CMS fee schedule,517.96,100,,,fee schedule,100% of APC rate,517.96,100,,,fee schedule,100% of APC rate,517.96,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,514,40,,411.2,percent of total billed charges,40% of total billed charges,188.43,1028,
IN/OUT CATH INSERTIO,8400010,CDM,760,RC,51701,HCPCS,Outpatient,,,136,108.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,36.02,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,36.02,108.8,
INSERT FOLEY CATH SI,8400010,CDM,760,RC,51702,HCPCS,Outpatient,,,136,108.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,35.47,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,35.47,108.8,
NASOTRACH SUCTION,8400010,CDM,760,RC,31720,HCPCS,Outpatient,,,410,328.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328,80,,262.4,percent of total billed charges,80% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,67.83,145,,,fee schedule,145% of CMS fee schedule,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164,40,,131.2,percent of total billed charges,40% of total billed charges,67.83,328,
CHNG PEG TUBE/NO IMA,8400010,CDM,760,RC,43762,HCPCS,Outpatient,,,477,381.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,381.6,80,,305.28,percent of total billed charges,80% of total billed charges,177.78,37.27,,142.22,percent of total billed charges,37.27% of total billed charges,177.78,37.27,,142.22,percent of total billed charges,37.27% of total billed charges,177.78,37.27,,142.22,percent of total billed charges,37.27% of total billed charges,203.77,100,,,fee schedule,100% of APC rate,203.77,100,,,fee schedule,100% of APC rate,203.77,100,,,fee schedule,100% of APC rate,53.23,145,,,fee schedule,145% of CMS fee schedule,203.77,100,,,fee schedule,100% of APC rate,203.77,100,,,fee schedule,100% of APC rate,203.77,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.8,40,,152.64,percent of total billed charges,40% of total billed charges,53.23,381.6,
BLOOD COLLECT FM PIC,8400010,CDM,760,RC,36592,HCPCS,Outpatient,,,175,140.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140,80,,112,percent of total billed charges,80% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,38.18,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70,40,,56,percent of total billed charges,40% of total billed charges,38.18,140,
BLOOD COLLECT FM POR,8400010,CDM,760,RC,36591,HCPCS,Outpatient,,,146,116.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,35.22,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,35.22,116.8,
PORT MAINT/FLUSH,8400010,CDM,760,RC,96523,HCPCS,Outpatient,,,128,102.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.4,80,,81.92,percent of total billed charges,80% of total billed charges,47.71,37.27,,38.17,percent of total billed charges,37.27% of total billed charges,47.71,37.27,,38.17,percent of total billed charges,37.27% of total billed charges,47.71,37.27,,38.17,percent of total billed charges,37.27% of total billed charges,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,32.07,145,,,fee schedule,145% of CMS fee schedule,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,40,,40.96,percent of total billed charges,40% of total billed charges,32.07,102.4,
REMOVE PICC/CNTRL LI,8400010,CDM,760,RC,36589,HCPCS,Outpatient,,,1285,1028.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1028,80,,822.4,percent of total billed charges,80% of total billed charges,478.92,37.27,,383.14,percent of total billed charges,37.27% of total billed charges,478.92,37.27,,383.14,percent of total billed charges,37.27% of total billed charges,478.92,37.27,,383.14,percent of total billed charges,37.27% of total billed charges,517.96,100,,,fee schedule,100% of APC rate,517.96,100,,,fee schedule,100% of APC rate,517.96,100,,,fee schedule,100% of APC rate,188.43,145,,,fee schedule,145% of CMS fee schedule,517.96,100,,,fee schedule,100% of APC rate,517.96,100,,,fee schedule,100% of APC rate,517.96,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,514,40,,411.2,percent of total billed charges,40% of total billed charges,188.43,1028,
IN/OUT CATH INSERTIO,8400010,CDM,760,RC,51701,HCPCS,Outpatient,,,136,108.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,36.02,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,36.02,108.8,
INSERT FOLEY CATH SI,8400010,CDM,760,RC,51702,HCPCS,Outpatient,,,136,108.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,35.47,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,35.47,108.8,
NASOTRACH SUCTION,8400010,CDM,760,RC,31720,HCPCS,Outpatient,,,410,328.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,328,80,,262.4,percent of total billed charges,80% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,152.81,37.27,,122.25,percent of total billed charges,37.27% of total billed charges,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,67.83,145,,,fee schedule,145% of CMS fee schedule,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164,40,,131.2,percent of total billed charges,40% of total billed charges,67.83,328,
CHNG PEG TUBE/NO IMA,8400010,CDM,760,RC,43762,HCPCS,Outpatient,,,477,381.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,381.6,80,,305.28,percent of total billed charges,80% of total billed charges,177.78,37.27,,142.22,percent of total billed charges,37.27% of total billed charges,177.78,37.27,,142.22,percent of total billed charges,37.27% of total billed charges,177.78,37.27,,142.22,percent of total billed charges,37.27% of total billed charges,203.77,100,,,fee schedule,100% of APC rate,203.77,100,,,fee schedule,100% of APC rate,203.77,100,,,fee schedule,100% of APC rate,53.23,145,,,fee schedule,145% of CMS fee schedule,203.77,100,,,fee schedule,100% of APC rate,203.77,100,,,fee schedule,100% of APC rate,203.77,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190.8,40,,152.64,percent of total billed charges,40% of total billed charges,53.23,381.6,
IV INF THERAPY INT,5811182,CDM,260,RC,96365,HCPCS,Outpatient,,,526,420.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.8,80,,336.64,percent of total billed charges,80% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,81.26,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,40,,168.32,percent of total billed charges,40% of total billed charges,81.26,420.8,
IV INF THER ADD HRS,5811182,CDM,260,RC,96366,HCPCS,Outpatient,,,123,98.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,26.98,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,40,,39.36,percent of total billed charges,40% of total billed charges,26.98,98.4,
IV HYDR INITIAL,5811182,CDM,260,RC,96360,HCPCS,Outpatient,,,222,177.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,42.15,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,40,,71.04,percent of total billed charges,40% of total billed charges,42.15,177.6,
IV HYDR EA ADDL,5811182,CDM,260,RC,96361,HCPCS,Outpatient,,,77,61.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,16.3,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,16.3,61.6,
IV INFUSION SEQ 1 HR,5811182,CDM,260,RC,96367,HCPCS,Outpatient,,,134,107.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,37.19,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,40,,42.88,percent of total billed charges,40% of total billed charges,37.19,107.2,
IV INFUSION CONCUR,5811182,CDM,260,RC,96368,HCPCS,Outpatient,,,146,116.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.09,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,26.09,116.8,
MULTIGEN,6400014,CDM,250,RC,,,Outpatient,,,4.2,3.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.36,80,,2.69,percent of total billed charges,80% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.57,37.27,,1.26,percent of total billed charges,37.27% 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,1.68,40,,1.34,percent of total billed charges,40% of total billed charges,1.57,3.36,
HECTORAL 0.5MCG,6065130,CDM,636,RC,,,Outpatient,,,59.45,47.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.56,80,,38.05,percent of total billed charges,80% of total billed charges,22.16,37.27,,17.73,percent of total billed charges,37.27% of total billed charges,22.16,37.27,,17.73,percent of total billed charges,37.27% of total billed charges,22.16,37.27,,17.73,percent of total billed charges,37.27% 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,23.78,40,,19.02,percent of total billed charges,40% of total billed charges,22.16,47.56,
OFIRMEV 1000MG/100ML,6400014,CDM,250,RC,J0131,HCPCS,Outpatient,,,0.44,0.35,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.35,80,,0.28,percent of total billed charges,80% of total billed charges,0.16,37.27,,0.13,percent of total billed charges,37.27% of total billed charges,0.16,37.27,,0.13,percent of total billed charges,37.27% of total billed charges,0.16,37.27,,0.13,percent of total billed charges,37.27% 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,0.18,40,,0.14,percent of total billed charges,40% of total billed charges,0.16,0.35,
GOLD BOND POWDER,6400014,CDM,250,RC,,,Outpatient,,,26.95,21.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.56,80,,17.25,percent of total billed charges,80% of total billed charges,10.04,37.27,,8.03,percent of total billed charges,37.27% of total billed charges,10.04,37.27,,8.03,percent of total billed charges,37.27% of total billed charges,10.04,37.27,,8.03,percent of total billed charges,37.27% 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,10.78,40,,8.62,percent of total billed charges,40% of total billed charges,10.04,21.56,
MINOR SURG PROC 1,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,241,192.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,192.8,80,,154.24,percent of total billed charges,80% of total billed charges,89.82,37.27,,71.86,percent of total billed charges,37.27% of total billed charges,89.82,37.27,,71.86,percent of total billed charges,37.27% of total billed charges,89.82,37.27,,71.86,percent of total billed charges,37.27% 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,96.4,40,,77.12,percent of total billed charges,40% of total billed charges,89.82,192.8,
MINOR SURG PROC II,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,477,381.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,381.6,80,,305.28,percent of total billed charges,80% of total billed charges,177.78,37.27,,142.22,percent of total billed charges,37.27% of total billed charges,177.78,37.27,,142.22,percent of total billed charges,37.27% of total billed charges,177.78,37.27,,142.22,percent of total billed charges,37.27% 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,190.8,40,,152.64,percent of total billed charges,40% of total billed charges,177.78,381.6,
MINOR SURG PROC III,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,866,692.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,692.8,80,,554.24,percent of total billed charges,80% of total billed charges,322.76,37.27,,258.21,percent of total billed charges,37.27% of total billed charges,322.76,37.27,,258.21,percent of total billed charges,37.27% of total billed charges,322.76,37.27,,258.21,percent of total billed charges,37.27% 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,346.4,40,,277.12,percent of total billed charges,40% of total billed charges,322.76,692.8,
MINOR SURG PROC I,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,554,443.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% 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,221.6,40,,177.28,percent of total billed charges,40% of total billed charges,206.48,443.2,
MINOR SURG PROC II,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,866,692.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,692.8,80,,554.24,percent of total billed charges,80% of total billed charges,322.76,37.27,,258.21,percent of total billed charges,37.27% of total billed charges,322.76,37.27,,258.21,percent of total billed charges,37.27% of total billed charges,322.76,37.27,,258.21,percent of total billed charges,37.27% 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,346.4,40,,277.12,percent of total billed charges,40% of total billed charges,322.76,692.8,
MINOR SURG PROC III,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,1129,903.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,903.2,80,,722.56,percent of total billed charges,80% of total billed charges,420.78,37.27,,336.62,percent of total billed charges,37.27% of total billed charges,420.78,37.27,,336.62,percent of total billed charges,37.27% of total billed charges,420.78,37.27,,336.62,percent of total billed charges,37.27% 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,451.6,40,,361.28,percent of total billed charges,40% of total billed charges,420.78,903.2,
TELE BLOOD TRANSFUS,5811120,CDM,391,RC,36430,HCPCS,Outpatient,,,1034,827.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,827.2,80,,661.76,percent of total billed charges,80% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,54.09,145,,,fee schedule,145% of CMS fee schedule,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,357.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413.6,40,,330.88,percent of total billed charges,40% of total billed charges,54.09,827.2,
AEROCHAMBER SM MASK,6400014,CDM,250,RC,,,Outpatient,,,168.8,135.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.04,80,,108.03,percent of total billed charges,80% of total billed charges,62.91,37.27,,50.33,percent of total billed charges,37.27% of total billed charges,62.91,37.27,,50.33,percent of total billed charges,37.27% of total billed charges,62.91,37.27,,50.33,percent of total billed charges,37.27% 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,67.52,40,,54.02,percent of total billed charges,40% of total billed charges,62.91,135.04,
NUCYNTA 75MG TAB,6400014,CDM,250,RC,,,Outpatient,,,49.4,39.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.52,80,,31.62,percent of total billed charges,80% of total billed charges,18.41,37.27,,14.73,percent of total billed charges,37.27% of total billed charges,18.41,37.27,,14.73,percent of total billed charges,37.27% of total billed charges,18.41,37.27,,14.73,percent of total billed charges,37.27% 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,19.76,40,,15.81,percent of total billed charges,40% of total billed charges,18.41,39.52,
LINCOCIN 300MG/ML,6065130,CDM,636,RC,J2010,HCPCS,Outpatient,,,179.45,143.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.56,80,,114.85,percent of total billed charges,80% of total billed charges,66.88,37.27,,53.5,percent of total billed charges,37.27% of total billed charges,66.88,37.27,,53.5,percent of total billed charges,37.27% of total billed charges,66.88,37.27,,53.5,percent of total billed charges,37.27% 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,71.78,40,,57.42,percent of total billed charges,40% of total billed charges,66.88,143.56,
ULORIC 40MG TAB,6400014,CDM,250,RC,,,Outpatient,,,45,36.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% 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,18,40,,14.4,percent of total billed charges,40% of total billed charges,16.77,36,
VERAPAMIL 80MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
PROVIGIL 100MG TAB,6400014,CDM,250,RC,,,Outpatient,,,87.8,70.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.24,80,,56.19,percent of total billed charges,80% of total billed charges,32.72,37.27,,26.18,percent of total billed charges,37.27% of total billed charges,32.72,37.27,,26.18,percent of total billed charges,37.27% of total billed charges,32.72,37.27,,26.18,percent of total billed charges,37.27% 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,35.12,40,,28.1,percent of total billed charges,40% of total billed charges,32.72,70.24,
SUDAFED PE 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
INSERT FOLEYCATH ER,8830002,CDM,450,RC,51702,HCPCS,Outpatient,,,136,108.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,35.47,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,35.47,108.8,
BACITRACTIN OPT OINT,5880901,CDM,637,RC,,,Outpatient,,,377.4,301.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,301.92,80,,241.54,percent of total billed charges,80% of total billed charges,140.66,37.27,,112.53,percent of total billed charges,37.27% of total billed charges,140.66,37.27,,112.53,percent of total billed charges,37.27% of total billed charges,140.66,37.27,,112.53,percent of total billed charges,37.27% 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,150.96,40,,120.77,percent of total billed charges,40% of total billed charges,140.66,301.92,
ENT VENT TUBES,5645742,CDM,270,RC,,,Outpatient,,,66,52.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% 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,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,24.6,52.8,
ENT SUCTION BOVIE,5645742,CDM,270,RC,,,Outpatient,,,49,39.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.2,80,,31.36,percent of total billed charges,80% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% of total billed charges,18.26,37.27,,14.61,percent of total billed charges,37.27% 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,19.6,40,,15.68,percent of total billed charges,40% of total billed charges,18.26,39.2,
ENT MYRINGOTOMY KNIF,5645742,CDM,270,RC,,,Outpatient,,,16,12.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% 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,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,5.96,12.8,
CODMAN PATTIES,5645742,CDM,270,RC,,,Outpatient,,,42,33.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.6,80,,26.88,percent of total billed charges,80% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% of total billed charges,15.65,37.27,,12.52,percent of total billed charges,37.27% 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,16.8,40,,13.44,percent of total billed charges,40% of total billed charges,15.65,33.6,
FLU VACCINE ADM FEE,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,27.36,59.2,
PNEUMONIA ADM,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,27.36,59.2,
PHENTOLAMINE 5MG INJ,6065130,CDM,636,RC,J2760,HCPCS,Outpatient,,,1769.7,1415.76,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1415.76,80,,1132.61,percent of total billed charges,80% of total billed charges,659.57,37.27,,527.66,percent of total billed charges,37.27% of total billed charges,659.57,37.27,,527.66,percent of total billed charges,37.27% of total billed charges,659.57,37.27,,527.66,percent of total billed charges,37.27% of total billed charges,367.12,100,,,fee schedule,100% of APC rate,367.12,100,,,fee schedule,100% of APC rate,367.12,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,367.12,100,,,fee schedule,100% of APC rate,367.12,100,,,fee schedule,100% of APC rate,367.12,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,707.88,40,,566.3,percent of total billed charges,40% of total billed charges,367.12,1415.76,
MEPERIDINE SYRUP 5ML,5880901,CDM,637,RC,,,Outpatient,,,5.55,4.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.44,80,,3.55,percent of total billed charges,80% of total billed charges,2.07,37.27,,1.66,percent of total billed charges,37.27% of total billed charges,2.07,37.27,,1.66,percent of total billed charges,37.27% of total billed charges,2.07,37.27,,1.66,percent of total billed charges,37.27% 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,2.22,40,,1.78,percent of total billed charges,40% of total billed charges,2.07,4.44,
MAG SULF 40GM/1000ML,6065130,CDM,636,RC,J3475,HCPCS,Outpatient,,,328.65,262.92,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.92,80,,210.34,percent of total billed charges,80% of total billed charges,122.49,37.27,,97.99,percent of total billed charges,37.27% of total billed charges,122.49,37.27,,97.99,percent of total billed charges,37.27% of total billed charges,122.49,37.27,,97.99,percent of total billed charges,37.27% 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,131.46,40,,105.17,percent of total billed charges,40% of total billed charges,122.49,262.92,
CIALIS 5MG TABLETS,5880901,CDM,637,RC,,,Outpatient,,,29.1,23.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.28,80,,18.62,percent of total billed charges,80% of total billed charges,10.85,37.27,,8.68,percent of total billed charges,37.27% of total billed charges,10.85,37.27,,8.68,percent of total billed charges,37.27% of total billed charges,10.85,37.27,,8.68,percent of total billed charges,37.27% 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,11.64,40,,9.31,percent of total billed charges,40% of total billed charges,10.85,23.28,
PROTONIX O/S PKT,6400014,CDM,250,RC,,,Outpatient,,,58.7,46.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.96,80,,37.57,percent of total billed charges,80% of total billed charges,21.88,37.27,,17.5,percent of total billed charges,37.27% of total billed charges,21.88,37.27,,17.5,percent of total billed charges,37.27% of total billed charges,21.88,37.27,,17.5,percent of total billed charges,37.27% 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,23.48,40,,18.78,percent of total billed charges,40% of total billed charges,21.88,46.96,
BLOOD ALCOHOL TESTIN,7012032,CDM,300,RC,,,Outpatient,,,29,23.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% 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,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,10.81,23.2,
MESH COMPOSITE 1015,8605396,CDM,278,RC,,,Outpatient,,,1387,1109.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1109.6,80,,887.68,percent of total billed charges,80% of total billed charges,516.93,37.27,,413.54,percent of total billed charges,37.27% of total billed charges,516.93,37.27,,413.54,percent of total billed charges,37.27% of total billed charges,516.93,37.27,,413.54,percent of total billed charges,37.27% 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,554.8,40,,443.84,percent of total billed charges,40% of total billed charges,516.93,1109.6,
THERMACHOICE BALLOON,8605396,CDM,278,RC,,,Outpatient,,,2224,1779.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1779.2,80,,1423.36,percent of total billed charges,80% of total billed charges,828.88,37.27,,663.1,percent of total billed charges,37.27% of total billed charges,828.88,37.27,,663.1,percent of total billed charges,37.27% of total billed charges,828.88,37.27,,663.1,percent of total billed charges,37.27% 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,889.6,40,,711.68,percent of total billed charges,40% of total billed charges,828.88,1779.2,
MOLE AMPLI TARGET,7000029,CDM,301,RC,83898,HCPCS,Outpatient,,,92,73.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% 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,36.8,40,,29.44,percent of total billed charges,40% of total billed charges,34.29,73.6,
MOLE AMP TARGET 1-2,7000029,CDM,301,RC,83900,HCPCS,Outpatient,,,185,148.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148,80,,118.4,percent of total billed charges,80% of total billed charges,68.95,37.27,,55.16,percent of total billed charges,37.27% of total billed charges,68.95,37.27,,55.16,percent of total billed charges,37.27% of total billed charges,68.95,37.27,,55.16,percent of total billed charges,37.27% 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,74,40,,59.2,percent of total billed charges,40% of total billed charges,68.95,148,
MOLE INTER/REPORT,7000029,CDM,301,RC,83912,HCPCS,Outpatient,,,22,17.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% 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,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,8.2,17.6,
MOLE ISO/EXT PURIFIE,7000029,CDM,301,RC,83891,HCPCS,Outpatient,,,22,17.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% 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,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,8.2,17.6,
MOLE NUCLEIC AC TRAN,7000029,CDM,301,RC,83897,HCPCS,Outpatient,,,22,17.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% 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,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,8.2,17.6,
MOLE SEPARATION,7000029,CDM,301,RC,83894,HCPCS,Outpatient,,,22,17.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% 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,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,8.2,17.6,
PCP CONFIRMATION UA,7000029,CDM,301,RC,83992,HCPCS,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
SUPREP BOWEL PREP,6400014,CDM,250,RC,,,Outpatient,,,236.7,189.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.36,80,,151.49,percent of total billed charges,80% of total billed charges,88.22,37.27,,70.58,percent of total billed charges,37.27% of total billed charges,88.22,37.27,,70.58,percent of total billed charges,37.27% of total billed charges,88.22,37.27,,70.58,percent of total billed charges,37.27% 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,94.68,40,,75.74,percent of total billed charges,40% of total billed charges,88.22,189.36,
HERPES SMEAR TZANCK,7039034,CDM,311,RC,88161,HCPCS,Outpatient,,,426,340.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,340.8,80,,272.64,percent of total billed charges,80% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% of total billed charges,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,72.56,145,,,fee schedule,145% of CMS fee schedule,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170.4,40,,136.32,percent of total billed charges,40% of total billed charges,24.55,340.8,
CLEARLAX(MIRALAX)BTL,6400014,CDM,250,RC,,,Outpatient,,,30.9,24.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.72,80,,19.78,percent of total billed charges,80% of total billed charges,11.52,37.27,,9.22,percent of total billed charges,37.27% of total billed charges,11.52,37.27,,9.22,percent of total billed charges,37.27% of total billed charges,11.52,37.27,,9.22,percent of total billed charges,37.27% 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,12.36,40,,9.89,percent of total billed charges,40% of total billed charges,11.52,24.72,
MOLE NUC ACD PRB 50+,7039034,CDM,311,RC,,,Outpatient,,,139,111.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,111.2,80,,88.96,percent of total billed charges,80% of total billed charges,51.81,37.27,,41.45,percent of total billed charges,37.27% of total billed charges,51.81,37.27,,41.45,percent of total billed charges,37.27% of total billed charges,51.81,37.27,,41.45,percent of total billed charges,37.27% 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,55.6,40,,44.48,percent of total billed charges,40% of total billed charges,51.81,111.2,
FER-IRON DROPS,5880901,CDM,637,RC,,,Outpatient,,,17.85,14.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.28,80,,11.42,percent of total billed charges,80% of total billed charges,6.65,37.27,,5.32,percent of total billed charges,37.27% of total billed charges,6.65,37.27,,5.32,percent of total billed charges,37.27% of total billed charges,6.65,37.27,,5.32,percent of total billed charges,37.27% 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,7.14,40,,5.71,percent of total billed charges,40% of total billed charges,6.65,14.28,
AVITENE 1GM SYRINGE,6400014,CDM,250,RC,,,Outpatient,,,614.6,491.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,491.68,80,,393.34,percent of total billed charges,80% of total billed charges,229.06,37.27,,183.25,percent of total billed charges,37.27% of total billed charges,229.06,37.27,,183.25,percent of total billed charges,37.27% of total billed charges,229.06,37.27,,183.25,percent of total billed charges,37.27% 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,245.84,40,,196.67,percent of total billed charges,40% of total billed charges,229.06,491.68,
LUMBAR W/BENDING VWS,6000392,CDM,320,RC,72114,HCPCS,Outpatient,,,473,378.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,378.4,80,,302.72,percent of total billed charges,80% of total billed charges,176.29,37.27,,141.03,percent of total billed charges,37.27% of total billed charges,176.29,37.27,,141.03,percent of total billed charges,37.27% of total billed charges,176.29,37.27,,141.03,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,59.74,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.2,40,,151.36,percent of total billed charges,40% of total billed charges,59.74,378.4,
FLU ADMINISTRATION,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,27.36,59.2,
PNEUM ADMINISTRATION,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,74,59.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,27.36,59.2,
VACCINE ADMIN 1ST,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,27.36,128,
VACCINE ADMIN 1ST,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,27.36,128,
MESH COMPOSITE 1520,8605396,CDM,278,RC,,,Outpatient,,,2519,2015.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2015.2,80,,1612.16,percent of total billed charges,80% of total billed charges,938.83,37.27,,751.06,percent of total billed charges,37.27% of total billed charges,938.83,37.27,,751.06,percent of total billed charges,37.27% of total billed charges,938.83,37.27,,751.06,percent of total billed charges,37.27% 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,1007.6,40,,806.08,percent of total billed charges,40% of total billed charges,938.83,2015.2,
MESH COMPOSITE 2025,8605396,CDM,278,RC,,,Outpatient,,,4080,3264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3264,80,,2611.2,percent of total billed charges,80% of total billed charges,1520.62,37.27,,1216.5,percent of total billed charges,37.27% of total billed charges,1520.62,37.27,,1216.5,percent of total billed charges,37.27% of total billed charges,1520.62,37.27,,1216.5,percent of total billed charges,37.27% 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,1632,40,,1305.6,percent of total billed charges,40% of total billed charges,1520.62,3264,
SECURESTRAP 25,8605396,CDM,278,RC,,,Outpatient,,,1173,938.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,938.4,80,,750.72,percent of total billed charges,80% of total billed charges,437.18,37.27,,349.74,percent of total billed charges,37.27% of total billed charges,437.18,37.27,,349.74,percent of total billed charges,37.27% of total billed charges,437.18,37.27,,349.74,percent of total billed charges,37.27% 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,469.2,40,,375.36,percent of total billed charges,40% of total billed charges,437.18,938.4,
XIBROM OPTHAL.SOLN.,6400014,CDM,250,RC,,,Outpatient,,,451.05,360.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360.84,80,,288.67,percent of total billed charges,80% of total billed charges,168.11,37.27,,134.49,percent of total billed charges,37.27% of total billed charges,168.11,37.27,,134.49,percent of total billed charges,37.27% of total billed charges,168.11,37.27,,134.49,percent of total billed charges,37.27% 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,180.42,40,,144.34,percent of total billed charges,40% of total billed charges,168.11,360.84,
HEMOFIL M FACT VIII,6400014,CDM,250,RC,J7190,HCPCS,Outpatient,,,4.85,3.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.88,80,,3.1,percent of total billed charges,80% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.17,100,,,fee schedule,100% of APC rate,1.17,100,,,fee schedule,100% of APC rate,1.17,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1.17,100,,,fee schedule,100% of APC rate,1.17,100,,,fee schedule,100% of APC rate,1.17,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.94,40,,1.55,percent of total billed charges,40% of total billed charges,1.17,3.88,
AVEENO SKIN REL WASH,5880901,CDM,637,RC,,,Outpatient,,,17.95,14.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.36,80,,11.49,percent of total billed charges,80% of total billed charges,6.69,37.27,,5.35,percent of total billed charges,37.27% of total billed charges,6.69,37.27,,5.35,percent of total billed charges,37.27% of total billed charges,6.69,37.27,,5.35,percent of total billed charges,37.27% 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,7.18,40,,5.74,percent of total billed charges,40% of total billed charges,6.69,14.36,
MIDAZOLAM SYRUP 2MG/,5880901,CDM,637,RC,,,Outpatient,,,36.7,29.36,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.36,80,,23.49,percent of total billed charges,80% of total billed charges,13.68,37.27,,10.94,percent of total billed charges,37.27% of total billed charges,13.68,37.27,,10.94,percent of total billed charges,37.27% of total billed charges,13.68,37.27,,10.94,percent of total billed charges,37.27% 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,14.68,40,,11.74,percent of total billed charges,40% of total billed charges,13.68,29.36,
MAGNES 1GM/100ML D5W,6065130,CDM,636,RC,J3475,HCPCS,Outpatient,,,33.3,26.64,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.64,80,,21.31,percent of total billed charges,80% of total billed charges,12.41,37.27,,9.93,percent of total billed charges,37.27% of total billed charges,12.41,37.27,,9.93,percent of total billed charges,37.27% of total billed charges,12.41,37.27,,9.93,percent of total billed charges,37.27% 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,13.32,40,,10.66,percent of total billed charges,40% of total billed charges,12.41,26.64,
ORENCIA(25X10MG),6065130,CDM,636,RC,J0129,HCPCS,Outpatient,,,129.78,103.82,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.82,80,,83.06,percent of total billed charges,80% of total billed charges,48.37,37.27,,38.7,percent of total billed charges,37.27% of total billed charges,48.37,37.27,,38.7,percent of total billed charges,37.27% of total billed charges,48.37,37.27,,38.7,percent of total billed charges,37.27% of total billed charges,43.44,100,,,fee schedule,100% of APC rate,43.44,100,,,fee schedule,100% of APC rate,43.44,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,43.44,100,,,fee schedule,100% of APC rate,43.44,100,,,fee schedule,100% of APC rate,43.44,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.91,40,,41.53,percent of total billed charges,40% of total billed charges,43.44,103.82,
IN/OUT CATH,8830002,CDM,450,RC,51701,HCPCS,Outpatient,,,136,108.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,36.02,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,36.02,108.8,
INSERT IN/OUT CATH,8400010,CDM,760,RC,51701,HCPCS,Outpatient,,,136,108.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,36.02,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,36.02,108.8,
PHENCYCLIDINE (PCP),7000029,CDM,301,RC,83992,HCPCS,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
MAG SULF 20ML INJ,6065130,CDM,636,RC,J3475,HCPCS,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
DEB SUBQ EA ADD 20,5612346,CDM,761,RC,11045,HCPCS,Outpatient,,,505,404.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404,80,,323.2,percent of total billed charges,80% of total billed charges,188.21,37.27,,150.57,percent of total billed charges,37.27% of total billed charges,188.21,37.27,,150.57,percent of total billed charges,37.27% of total billed charges,188.21,37.27,,150.57,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.73,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202,40,,161.6,percent of total billed charges,40% of total billed charges,35.73,404,
DEB MUS/FAS EAADD 20,5612346,CDM,761,RC,11046,HCPCS,Outpatient,,,1036,828.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,828.8,80,,663.04,percent of total billed charges,80% of total billed charges,386.12,37.27,,308.9,percent of total billed charges,37.27% of total billed charges,386.12,37.27,,308.9,percent of total billed charges,37.27% of total billed charges,386.12,37.27,,308.9,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.53,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,414.4,40,,331.52,percent of total billed charges,40% of total billed charges,77.53,828.8,
DEB BONE EA ADD 20,5612346,CDM,761,RC,11047,HCPCS,Outpatient,,,1567,1253.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1253.6,80,,1002.88,percent of total billed charges,80% of total billed charges,584.02,37.27,,467.22,percent of total billed charges,37.27% of total billed charges,584.02,37.27,,467.22,percent of total billed charges,37.27% of total billed charges,584.02,37.27,,467.22,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,137.07,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,626.8,40,,501.44,percent of total billed charges,40% of total billed charges,137.07,1253.6,
APPLIC COMPR BELOW R,5612353,CDM,510,RC,29581,HCPCS,Outpatient,,,375.3,300.24,RT,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,300.24,80,,240.19,percent of total billed charges,80% of total billed charges,139.87,37.27,,111.9,percent of total billed charges,37.27% of total billed charges,139.87,37.27,,111.9,percent of total billed charges,37.27% of total billed charges,139.87,37.27,,111.9,percent of total billed charges,37.27% of total billed charges,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,37.12,145,,,fee schedule,145% of CMS fee schedule,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,37.12,300.24,
ACID GONE ANTACID,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
AIRWAY LTS,5645742,CDM,270,RC,,,Outpatient,,,106,84.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.8,80,,67.84,percent of total billed charges,80% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% of total billed charges,39.51,37.27,,31.61,percent of total billed charges,37.27% 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,42.4,40,,33.92,percent of total billed charges,40% of total billed charges,39.51,84.8,
LMA SUPREME,5645742,CDM,270,RC,,,Outpatient,,,64,51.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% 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,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,23.85,51.2,
SURGICELL 4 X 8,5645742,CDM,270,RC,,,Outpatient,,,92,73.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% 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,36.8,40,,29.44,percent of total billed charges,40% of total billed charges,34.29,73.6,
CSF ENCEPHALITIS PNL,7000284,CDM,306,RC,,,Outpatient,,,90,72.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% 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,36,40,,28.8,percent of total billed charges,40% of total billed charges,33.54,72,
HSV 1&2 IGM INDIR AB,7000169,CDM,302,RC,,,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% 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,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,27.58,59.2,
DISTAL ATTACHMENT,5645742,CDM,270,RC,,,Outpatient,,,100,80.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% 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,40,40,,32,percent of total billed charges,40% of total billed charges,37.27,80,
LEVAQUIN 250MG IVPB,6065130,CDM,636,RC,J1956,HCPCS,Outpatient,,,74.7,59.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.76,80,,47.81,percent of total billed charges,80% of total billed charges,27.84,37.27,,22.27,percent of total billed charges,37.27% of total billed charges,27.84,37.27,,22.27,percent of total billed charges,37.27% of total billed charges,27.84,37.27,,22.27,percent of total billed charges,37.27% 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,29.88,40,,23.9,percent of total billed charges,40% of total billed charges,27.84,59.76,
MIDAZOLAM 2MG/2MLINJ,6065130,CDM,636,RC,J2250,HCPCS,Outpatient,,,13.1,10.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.48,80,,8.38,percent of total billed charges,80% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% 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,5.24,40,,4.19,percent of total billed charges,40% of total billed charges,4.88,10.48,
CATH UMBILICAL VESSE,5645742,CDM,270,RC,,,Outpatient,,,63,50.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% 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,25.2,40,,20.16,percent of total billed charges,40% of total billed charges,23.48,50.4,
XOPENEX 0.63MG,6400014,CDM,250,RC,J7614,HCPCS,Outpatient,,,40.35,32.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.28,80,,25.82,percent of total billed charges,80% of total billed charges,15.04,37.27,,12.03,percent of total billed charges,37.27% of total billed charges,15.04,37.27,,12.03,percent of total billed charges,37.27% of total billed charges,15.04,37.27,,12.03,percent of total billed charges,37.27% 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,16.14,40,,12.91,percent of total billed charges,40% of total billed charges,15.04,32.28,
XOPENEX 0.31MG,6400014,CDM,250,RC,J7614,HCPCS,Outpatient,,,40.35,32.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.28,80,,25.82,percent of total billed charges,80% of total billed charges,15.04,37.27,,12.03,percent of total billed charges,37.27% of total billed charges,15.04,37.27,,12.03,percent of total billed charges,37.27% of total billed charges,15.04,37.27,,12.03,percent of total billed charges,37.27% 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,16.14,40,,12.91,percent of total billed charges,40% of total billed charges,15.04,32.28,
FLUORESCEIN STRIP,6400014,CDM,250,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
DIAZEPAM 5MG/ML 10ML,6065130,CDM,636,RC,J3360,HCPCS,Outpatient,,,20.5,16.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.4,80,,13.12,percent of total billed charges,80% of total billed charges,7.64,37.27,,6.11,percent of total billed charges,37.27% of total billed charges,7.64,37.27,,6.11,percent of total billed charges,37.27% of total billed charges,7.64,37.27,,6.11,percent of total billed charges,37.27% 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,8.2,40,,6.56,percent of total billed charges,40% of total billed charges,7.64,16.4,
BACT WATER FOR INJ,6400014,CDM,250,RC,,,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
BACTINE,6400014,CDM,250,RC,,,Outpatient,,,12.5,10.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,80,,8,percent of total billed charges,80% of total billed charges,4.66,37.27,,3.73,percent of total billed charges,37.27% of total billed charges,4.66,37.27,,3.73,percent of total billed charges,37.27% of total billed charges,4.66,37.27,,3.73,percent of total billed charges,37.27% 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,5,40,,4,percent of total billed charges,40% of total billed charges,4.66,10,
PEAK FLOW METER,5645742,CDM,270,RC,,,Outpatient,,,29,23.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.2,80,,18.56,percent of total billed charges,80% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% of total billed charges,10.81,37.27,,8.65,percent of total billed charges,37.27% 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,11.6,40,,9.28,percent of total billed charges,40% of total billed charges,10.81,23.2,
AEROCHAMBER SPACER,5645742,CDM,270,RC,,,Outpatient,,,21,16.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.8,80,,13.44,percent of total billed charges,80% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% of total billed charges,7.83,37.27,,6.26,percent of total billed charges,37.27% 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,8.4,40,,6.72,percent of total billed charges,40% of total billed charges,7.83,16.8,
TEE ADAPTER,5645742,CDM,270,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
HEATED MOISTURE EXCH,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
INCENTIVE SPIROMETER,5645742,CDM,270,RC,,,Outpatient,,,23,18.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% 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,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,8.57,18.4,
AMPHETAMINE CONFORMA,7000029,CDM,301,RC,80324,HCPCS,Outpatient,,,228.86,183.09,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.09,80,,146.47,percent of total billed charges,80% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% 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,91.54,40,,73.23,percent of total billed charges,40% of total billed charges,85.3,183.09,
CELIAC DISEASE SEROL,7000029,CDM,301,RC,,,Outpatient,,,388,310.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% 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,155.2,40,,124.16,percent of total billed charges,40% of total billed charges,144.61,310.4,
VONWILLEBRAND PROFIL,7000177,CDM,305,RC,,,Outpatient,,,526,420.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.8,80,,336.64,percent of total billed charges,80% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% 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,210.4,40,,168.32,percent of total billed charges,40% of total billed charges,196.04,420.8,
OSMOLITE 1.5CAL CAN,6400014,CDM,250,RC,,,Outpatient,,,7.9,6.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.32,80,,5.06,percent of total billed charges,80% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% of total billed charges,2.94,37.27,,2.35,percent of total billed charges,37.27% 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,3.16,40,,2.53,percent of total billed charges,40% of total billed charges,2.94,6.32,
DALIRESP 500MCG,6400014,CDM,250,RC,,,Outpatient,,,57.05,45.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.64,80,,36.51,percent of total billed charges,80% of total billed charges,21.26,37.27,,17.01,percent of total billed charges,37.27% of total billed charges,21.26,37.27,,17.01,percent of total billed charges,37.27% of total billed charges,21.26,37.27,,17.01,percent of total billed charges,37.27% 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,22.82,40,,18.26,percent of total billed charges,40% of total billed charges,21.26,45.64,
SUTURE 810,5645742,CDM,270,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
SUTURE 811,5645742,CDM,270,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
PAIN/FEVER LIQUID,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
TYLENOL ES LIQ 5ML,6400014,CDM,250,RC,,,Outpatient,,,11.95,9.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.56,80,,7.65,percent of total billed charges,80% of total billed charges,4.45,37.27,,3.56,percent of total billed charges,37.27% of total billed charges,4.45,37.27,,3.56,percent of total billed charges,37.27% of total billed charges,4.45,37.27,,3.56,percent of total billed charges,37.27% 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,4.78,40,,3.82,percent of total billed charges,40% of total billed charges,4.45,9.56,
PROLIA 60MG INJ,6065130,CDM,636,RC,J0897,HCPCS,Outpatient,,,82.16,65.73,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.73,80,,52.58,percent of total billed charges,80% of total billed charges,30.62,37.27,,24.5,percent of total billed charges,37.27% of total billed charges,30.62,37.27,,24.5,percent of total billed charges,37.27% of total billed charges,30.62,37.27,,24.5,percent of total billed charges,37.27% of total billed charges,26.96,100,,,fee schedule,100% of APC rate,26.96,100,,,fee schedule,100% of APC rate,26.96,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,26.96,100,,,fee schedule,100% of APC rate,26.96,100,,,fee schedule,100% of APC rate,26.96,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.86,40,,26.29,percent of total billed charges,40% of total billed charges,26.96,65.73,
NADOLOL 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.05,2.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.44,80,,1.95,percent of total billed charges,80% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% of total billed charges,1.14,37.27,,0.91,percent of total billed charges,37.27% 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,1.22,40,,0.98,percent of total billed charges,40% of total billed charges,1.14,2.44,
C-ARM 1ST HOUR,6000392,CDM,320,RC,76000,HCPCS,Outpatient,,,449,359.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,359.2,80,,287.36,percent of total billed charges,80% of total billed charges,167.34,37.27,,133.87,percent of total billed charges,37.27% of total billed charges,167.34,37.27,,133.87,percent of total billed charges,37.27% of total billed charges,167.34,37.27,,133.87,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,35.64,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.6,40,,143.68,percent of total billed charges,40% of total billed charges,35.64,359.2,
WRIST 2 VWS,6000392,CDM,320,RC,73100,HCPCS,Outpatient,,,263,210.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,33.1,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.2,40,,84.16,percent of total billed charges,40% of total billed charges,33.1,210.4,
RIB LT 2VWS,6000392,CDM,320,RC,71100,HCPCS,Outpatient,,,263,210.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,33.52,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.2,40,,84.16,percent of total billed charges,40% of total billed charges,33.52,210.4,
HAND 3+ VWS,6000392,CDM,320,RC,73130,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,36.9,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,36.9,300,
ELBOW 2 VWS,6000392,CDM,320,RC,73070,HCPCS,Outpatient,,,263,210.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,27.19,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.2,40,,84.16,percent of total billed charges,40% of total billed charges,27.19,210.4,
CHEST 2 W/LORDOTIC,6000392,CDM,320,RC,71047,HCPCS,Outpatient,,,302,241.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,241.6,80,,193.28,percent of total billed charges,80% of total billed charges,112.56,37.27,,90.05,percent of total billed charges,37.27% of total billed charges,112.56,37.27,,90.05,percent of total billed charges,37.27% of total billed charges,112.56,37.27,,90.05,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,37.32,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.8,40,,96.64,percent of total billed charges,40% of total billed charges,37.32,241.6,
CHEST W/OBLIQUES,6000392,CDM,320,RC,71048,HCPCS,Outpatient,,,333,266.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,266.4,80,,213.12,percent of total billed charges,80% of total billed charges,124.11,37.27,,99.29,percent of total billed charges,37.27% of total billed charges,124.11,37.27,,99.29,percent of total billed charges,37.27% of total billed charges,124.11,37.27,,99.29,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,39.86,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.2,40,,106.56,percent of total billed charges,40% of total billed charges,39.86,266.4,
HIP BI W/PELVIS 3+VW,6000392,CDM,320,RC,73522,HCPCS,Outpatient,,,368,294.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,50.87,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.2,40,,117.76,percent of total billed charges,40% of total billed charges,50.87,294.4,
KNEES AP STANDING BL,6000392,CDM,320,RC,73565,HCPCS,Outpatient,,,330,264.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,40.72,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,40.72,264,
KNEE 4+ VIEWS,6000392,CDM,320,RC,73564,HCPCS,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,46.21,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150,40,,120,percent of total billed charges,40% of total billed charges,46.21,300,
KNEE/PATELLA 1-2 VWS,6000392,CDM,320,RC,73560,HCPCS,Outpatient,,,300,240.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,33.52,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,33.52,240,
ANKLE 2 VIEWS,6000392,CDM,320,RC,73600,HCPCS,Outpatient,,,300,240.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,31.41,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,31.41,240,
STAT LOCK,5645742,CDM,270,RC,,,Outpatient,,,22,17.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% 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,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,8.2,17.6,
BIO PATCH,5645742,CDM,270,RC,,,Outpatient,,,34,27.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% 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,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,12.67,27.2,
US CHEST,6000566,CDM,402,RC,76604,HCPCS,Outpatient,,,428,342.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,342.4,80,,273.92,percent of total billed charges,80% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,38.6,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.2,40,,136.96,percent of total billed charges,40% of total billed charges,38.6,342.4,
US BLADDER POST VOID,6000566,CDM,402,RC,51798,HCPCS,Outpatient,,,140,112.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112,80,,89.6,percent of total billed charges,80% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,14.5,145,,,fee schedule,145% of CMS fee schedule,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,40,,44.8,percent of total billed charges,40% of total billed charges,14.5,112,
THORACIC SPINE 3 VWS,6000392,CDM,320,RC,72072,HCPCS,Outpatient,,,315,252.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252,80,,201.6,percent of total billed charges,80% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,36.9,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126,40,,100.8,percent of total billed charges,40% of total billed charges,36.9,252,
MANDIBLE LTD<4 VWS,6000392,CDM,320,RC,70100,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,38.6,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,40,,105.6,percent of total billed charges,40% of total billed charges,38.6,264,
NM LEXI INJ 0.4/0.1M,6065130,CDM,636,RC,J2785,HCPCS,Outpatient,,,466,372.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,372.8,80,,298.24,percent of total billed charges,80% of total billed charges,173.68,37.27,,138.94,percent of total billed charges,37.27% of total billed charges,173.68,37.27,,138.94,percent of total billed charges,37.27% of total billed charges,173.68,37.27,,138.94,percent of total billed charges,37.27% 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,186.4,40,,149.12,percent of total billed charges,40% of total billed charges,173.68,372.8,
FALLOPIAN RING,5645742,CDM,270,RC,,,Outpatient,,,79,63.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.2,80,,50.56,percent of total billed charges,80% of total billed charges,29.44,37.27,,23.55,percent of total billed charges,37.27% of total billed charges,29.44,37.27,,23.55,percent of total billed charges,37.27% of total billed charges,29.44,37.27,,23.55,percent of total billed charges,37.27% 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,31.6,40,,25.28,percent of total billed charges,40% of total billed charges,29.44,63.2,
HARMONIC ACE,5645742,CDM,270,RC,,,Outpatient,,,1104,883.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,883.2,80,,706.56,percent of total billed charges,80% of total billed charges,411.46,37.27,,329.17,percent of total billed charges,37.27% of total billed charges,411.46,37.27,,329.17,percent of total billed charges,37.27% of total billed charges,411.46,37.27,,329.17,percent of total billed charges,37.27% 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,441.6,40,,353.28,percent of total billed charges,40% of total billed charges,411.46,883.2,
INSERT FOLEYCATH OB,8400010,CDM,760,RC,51702,HCPCS,Outpatient,,,136,108.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,35.47,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,35.47,108.8,
IN/OUT CATH INSERTIO,8400010,CDM,760,RC,51701,HCPCS,Outpatient,,,136,108.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,36.02,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,36.02,108.8,
RAZADYNE 8MG TAB,6400014,CDM,250,RC,,,Outpatient,,,21.8,17.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.44,80,,13.95,percent of total billed charges,80% of total billed charges,8.12,37.27,,6.5,percent of total billed charges,37.27% of total billed charges,8.12,37.27,,6.5,percent of total billed charges,37.27% of total billed charges,8.12,37.27,,6.5,percent of total billed charges,37.27% 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,8.72,40,,6.98,percent of total billed charges,40% of total billed charges,8.12,17.44,
EFFIENT 10MG TAB,5880901,CDM,637,RC,,,Outpatient,,,62.6,50.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.08,80,,40.06,percent of total billed charges,80% of total billed charges,23.33,37.27,,18.66,percent of total billed charges,37.27% of total billed charges,23.33,37.27,,18.66,percent of total billed charges,37.27% of total billed charges,23.33,37.27,,18.66,percent of total billed charges,37.27% 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,25.04,40,,20.03,percent of total billed charges,40% of total billed charges,23.33,50.08,
ALDEX D SUSPENSION,6400014,CDM,250,RC,,,Outpatient,,,63.1,50.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.48,80,,40.38,percent of total billed charges,80% of total billed charges,23.52,37.27,,18.82,percent of total billed charges,37.27% of total billed charges,23.52,37.27,,18.82,percent of total billed charges,37.27% of total billed charges,23.52,37.27,,18.82,percent of total billed charges,37.27% 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,25.24,40,,20.19,percent of total billed charges,40% of total billed charges,23.52,50.48,
CLOZARIL LEVEL,7000029,CDM,301,RC,80346,HCPCS,Outpatient,,,228.86,183.09,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,183.09,80,,146.47,percent of total billed charges,80% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% of total billed charges,85.3,37.27,,68.24,percent of total billed charges,37.27% 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,91.54,40,,73.23,percent of total billed charges,40% of total billed charges,85.3,183.09,
BETA 2 GLYCOPRO ANTI,7012032,CDM,300,RC,,,Outpatient,,,192,153.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,71.56,37.27,,57.25,percent of total billed charges,37.27% of total billed charges,71.56,37.27,,57.25,percent of total billed charges,37.27% of total billed charges,71.56,37.27,,57.25,percent of total billed charges,37.27% 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,76.8,40,,61.44,percent of total billed charges,40% of total billed charges,71.56,153.6,
MYCOPLASMA PNEUMONIA,7000169,CDM,302,RC,,,Outpatient,,,394,315.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,315.2,80,,252.16,percent of total billed charges,80% of total billed charges,146.84,37.27,,117.47,percent of total billed charges,37.27% of total billed charges,146.84,37.27,,117.47,percent of total billed charges,37.27% of total billed charges,146.84,37.27,,117.47,percent of total billed charges,37.27% 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,157.6,40,,126.08,percent of total billed charges,40% of total billed charges,146.84,315.2,
CARDENE 20MG PREMIX,6065130,CDM,636,RC,J2404,HCPCS,Outpatient,,,459.15,367.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,367.32,80,,293.86,percent of total billed charges,80% of total billed charges,171.13,37.27,,136.9,percent of total billed charges,37.27% of total billed charges,171.13,37.27,,136.9,percent of total billed charges,37.27% of total billed charges,171.13,37.27,,136.9,percent of total billed charges,37.27% 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,183.66,40,,146.93,percent of total billed charges,40% of total billed charges,171.13,367.32,
TRADJENTA 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,71.6,57.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.28,80,,45.82,percent of total billed charges,80% of total billed charges,26.69,37.27,,21.35,percent of total billed charges,37.27% of total billed charges,26.69,37.27,,21.35,percent of total billed charges,37.27% of total billed charges,26.69,37.27,,21.35,percent of total billed charges,37.27% 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,28.64,40,,22.91,percent of total billed charges,40% of total billed charges,26.69,57.28,
LORAZEPAM 2MG/ML(ML),6065130,CDM,636,RC,J2060,HCPCS,Outpatient,,,13.1,10.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.48,80,,8.38,percent of total billed charges,80% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% 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,5.24,40,,4.19,percent of total billed charges,40% of total billed charges,4.88,10.48,
VITAMIN D3 5000 UN,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CASTOR OIL 4 OZ.,5880901,CDM,637,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
PROTRACTOR MED,5645742,CDM,270,RC,,,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
PROTRACTOR LAR,5645742,CDM,270,RC,,,Outpatient,,,286,228.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% 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,114.4,40,,91.52,percent of total billed charges,40% of total billed charges,106.59,228.8,
PROTRACTOR XLAR,5645742,CDM,270,RC,,,Outpatient,,,286,228.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% 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,114.4,40,,91.52,percent of total billed charges,40% of total billed charges,106.59,228.8,
IV NS 25 ML,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
IV SOD CHL 45% 20MEG,5753355,CDM,258,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
IV NS 3000CC SOD CHL,5753355,CDM,258,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
STATLOC PICC PLUS,5645742,CDM,270,RC,,,Outpatient,,,26,20.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.8,80,,16.64,percent of total billed charges,80% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% of total billed charges,9.69,37.27,,7.75,percent of total billed charges,37.27% 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,10.4,40,,8.32,percent of total billed charges,40% of total billed charges,9.69,20.8,
CIRCUMCISION DVC 1.2,5645742,CDM,270,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
CIRCUMCISION DVC 1.3,5645742,CDM,270,RC,,,Outpatient,,,16,12.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% 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,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,5.96,12.8,
CIRCUMCISION DVC 1.4,5645742,CDM,270,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
TUBE ENDO 6.0-8.0 CU,5801832,CDM,272,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
TUBE ENDO 8.5-9.5 CU,5801832,CDM,272,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
TUBE ENDO 10.0 CUFF,5801832,CDM,272,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
TRAY LUMBAR PUNC PED,5801832,CDM,272,RC,,,Outpatient,,,123,98.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% 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,49.2,40,,39.36,percent of total billed charges,40% of total billed charges,45.84,98.4,
TRAY LUMBAR PUNC ADU,5801832,CDM,272,RC,,,Outpatient,,,95,76.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% 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,38,40,,30.4,percent of total billed charges,40% of total billed charges,35.41,76,
WOUND VAC DRESNG LG,5801832,CDM,272,RC,,,Outpatient,,,195,156.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156,80,,124.8,percent of total billed charges,80% of total billed charges,72.68,37.27,,58.14,percent of total billed charges,37.27% of total billed charges,72.68,37.27,,58.14,percent of total billed charges,37.27% of total billed charges,72.68,37.27,,58.14,percent of total billed charges,37.27% 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,78,40,,62.4,percent of total billed charges,40% of total billed charges,72.68,156,
WOUND VAC DRESNG ABD,5801832,CDM,272,RC,,,Outpatient,,,195,156.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156,80,,124.8,percent of total billed charges,80% of total billed charges,72.68,37.27,,58.14,percent of total billed charges,37.27% of total billed charges,72.68,37.27,,58.14,percent of total billed charges,37.27% of total billed charges,72.68,37.27,,58.14,percent of total billed charges,37.27% 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,78,40,,62.4,percent of total billed charges,40% of total billed charges,72.68,156,
AIRWAY 60MM,5801832,CDM,272,RC,,,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% 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,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,10.44,22.4,
AIRWAY 80MM,5801832,CDM,272,RC,,,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% 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,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,10.06,21.6,
AIRWAY 90MM,5801832,CDM,272,RC,,,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% 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,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,10.06,21.6,
AIRWAY CHILD SZ 1,5801832,CDM,272,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
AIRWAY 70MM,5801832,CDM,272,RC,,,Outpatient,,,48,38.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% 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,19.2,40,,15.36,percent of total billed charges,40% of total billed charges,17.89,38.4,
IV CATH DESERET 24 G,5801832,CDM,272,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
IV CATH JELCO 16G,5801832,CDM,272,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
CANN SUC COMCO3001,5645742,CDM,270,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
BANDAGE ACE 5,5801832,CDM,272,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
CATH FOLEY 10F,5801832,CDM,272,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
CATH FOLEY 8F,5801832,CDM,272,RC,,,Outpatient,,,40,32.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% 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,16,40,,12.8,percent of total billed charges,40% of total billed charges,14.91,32,
CATH FOLEY 26F,5801832,CDM,272,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
CLIPPER BLADE DISP,5801832,CDM,272,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
ELECTRO QCK COMBO PE,5801832,CDM,272,RC,,,Outpatient,,,105,84.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% 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,42,40,,33.6,percent of total billed charges,40% of total billed charges,39.13,84,
AIRWAY CHILD SZ 0,5801832,CDM,272,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
SLING ARM PEDI,5645742,CDM,270,RC,,,Outpatient,,,16,12.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% 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,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,5.96,12.8,
PERCUT SHEATH INT 6F,5801832,CDM,272,RC,C1892,HCPCS,Outpatient,,,119,95.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% 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,47.6,40,,38.08,percent of total billed charges,40% of total billed charges,44.35,95.2,
NDL SPINAL 20X13 1/2,5645742,CDM,270,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
NDL SPINAL 22X1 1/2,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
NDL SPINAL22X3.5 1/2,5645742,CDM,270,RC,,,Outpatient,,,23,18.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,80,,14.72,percent of total billed charges,80% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% of total billed charges,8.57,37.27,,6.86,percent of total billed charges,37.27% 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,9.2,40,,7.36,percent of total billed charges,40% of total billed charges,8.57,18.4,
NDL SPINAL 22X5 QUIN,5645742,CDM,270,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
NDL SPINAL 25X3 1/2,5645742,CDM,270,RC,,,Outpatient,,,24,19.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.2,80,,15.36,percent of total billed charges,80% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% of total billed charges,8.94,37.27,,7.15,percent of total billed charges,37.27% 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,9.6,40,,7.68,percent of total billed charges,40% of total billed charges,8.94,19.2,
STOCKING KNEE LG REG,5645742,CDM,270,RC,,,Outpatient,,,19,15.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.2,80,,12.16,percent of total billed charges,80% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% of total billed charges,7.08,37.27,,5.66,percent of total billed charges,37.27% 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,7.6,40,,6.08,percent of total billed charges,40% of total billed charges,7.08,15.2,
STOCKING THIGH LG RG,5645742,CDM,270,RC,,,Outpatient,,,33,26.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% 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,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,12.3,26.4,
STOCKING THIGH LG SH,5645742,CDM,270,RC,,,Outpatient,,,66,52.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.8,80,,42.24,percent of total billed charges,80% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% of total billed charges,24.6,37.27,,19.68,percent of total billed charges,37.27% 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,26.4,40,,21.12,percent of total billed charges,40% of total billed charges,24.6,52.8,
STOCKING THIGH LG LO,5645742,CDM,270,RC,,,Outpatient,,,33,26.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% 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,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,12.3,26.4,
STOCKING THIGH MDLON,5645742,CDM,270,RC,,,Outpatient,,,36,28.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,28.8,80,,23.04,percent of total billed charges,80% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% of total billed charges,13.42,37.27,,10.74,percent of total billed charges,37.27% 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,14.4,40,,11.52,percent of total billed charges,40% of total billed charges,13.42,28.8,
STOCKING THIGH MD SH,5645742,CDM,270,RC,,,Outpatient,,,33,26.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% 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,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,12.3,26.4,
SUTURE J317H GL123,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
TUBE TRAC DIS PED 4.,5801832,CDM,272,RC,,,Outpatient,,,161,128.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% 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,64.4,40,,51.52,percent of total billed charges,40% of total billed charges,60,128.8,
TUBE TRACH 4DCFS,5801832,CDM,272,RC,,,Outpatient,,,182,145.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% 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,72.8,40,,58.24,percent of total billed charges,40% of total billed charges,67.83,145.6,
SHOE PROT MEN M-XL,5645742,CDM,270,RC,,,Outpatient,,,56,44.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% 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,22.4,40,,17.92,percent of total billed charges,40% of total billed charges,20.87,44.8,
SALEM SUMP TB 14-18,5801832,CDM,272,RC,,,Outpatient,,,22,17.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% 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,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,8.2,17.6,
TUBE TRAC 7DIC CUFF,5801832,CDM,272,RC,,,Outpatient,,,149,119.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% 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,59.6,40,,47.68,percent of total billed charges,40% of total billed charges,55.53,119.2,
TROCAR 10MM BLNT TIP,5645742,CDM,270,RC,,,Outpatient,,,521,416.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,416.8,80,,333.44,percent of total billed charges,80% of total billed charges,194.18,37.27,,155.34,percent of total billed charges,37.27% of total billed charges,194.18,37.27,,155.34,percent of total billed charges,37.27% of total billed charges,194.18,37.27,,155.34,percent of total billed charges,37.27% 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,208.4,40,,166.72,percent of total billed charges,40% of total billed charges,194.18,416.8,
CHEMICAL MODIFICATIO,7000169,CDM,302,RC,86905,HCPCS,Outpatient,,,246,196.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.8,80,,157.44,percent of total billed charges,80% of total billed charges,91.68,37.27,,73.34,percent of total billed charges,37.27% of total billed charges,91.68,37.27,,73.34,percent of total billed charges,37.27% of total billed charges,91.68,37.27,,73.34,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,3.83,100,,,fee schedule,100% of CMS fee schedule,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,40,,78.72,percent of total billed charges,40% of total billed charges,3.83,296.36,
CTA ABD&PELVIS W/WO,6010052,CDM,350,RC,74174,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,365.82,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,317.08,2412.8,
NM HIDA W/O,6001655,CDM,341,RC,78226,HCPCS,Outpatient,,,963,770.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,770.4,80,,616.32,percent of total billed charges,80% of total billed charges,358.91,37.27,,287.13,percent of total billed charges,37.27% of total billed charges,358.91,37.27,,287.13,percent of total billed charges,37.27% of total billed charges,358.91,37.27,,287.13,percent of total billed charges,37.27% of total billed charges,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,333.4,145,,,fee schedule,145% of CMS fee schedule,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,385.2,40,,308.16,percent of total billed charges,40% of total billed charges,333.4,770.4,
NM HIDA W/CCK,6001655,CDM,341,RC,78227,HCPCS,Outpatient,,,1335,1068.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1068,80,,854.4,percent of total billed charges,80% of total billed charges,497.55,37.27,,398.04,percent of total billed charges,37.27% of total billed charges,497.55,37.27,,398.04,percent of total billed charges,37.27% of total billed charges,497.55,37.27,,398.04,percent of total billed charges,37.27% of total billed charges,445.65,100,,,fee schedule,100% of APC rate,445.65,100,,,fee schedule,100% of APC rate,445.65,100,,,fee schedule,100% of APC rate,453.31,145,,,fee schedule,145% of CMS fee schedule,445.65,100,,,fee schedule,100% of APC rate,445.65,100,,,fee schedule,100% of APC rate,445.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534,40,,427.2,percent of total billed charges,40% of total billed charges,445.65,1068,
NM LUNG SCN VENT OLY,6001655,CDM,341,RC,78579,HCPCS,Outpatient,,,958,766.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,766.4,80,,613.12,percent of total billed charges,80% of total billed charges,357.05,37.27,,285.64,percent of total billed charges,37.27% of total billed charges,357.05,37.27,,285.64,percent of total billed charges,37.27% of total billed charges,357.05,37.27,,285.64,percent of total billed charges,37.27% of total billed charges,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,190.65,145,,,fee schedule,145% of CMS fee schedule,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,383.2,40,,306.56,percent of total billed charges,40% of total billed charges,190.65,766.4,
NM LUNG VENT PERF,6001655,CDM,341,RC,78582,HCPCS,Outpatient,,,1335,1068.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1068,80,,854.4,percent of total billed charges,80% of total billed charges,497.55,37.27,,398.04,percent of total billed charges,37.27% of total billed charges,497.55,37.27,,398.04,percent of total billed charges,37.27% of total billed charges,497.55,37.27,,398.04,percent of total billed charges,37.27% of total billed charges,445.65,100,,,fee schedule,100% of APC rate,445.65,100,,,fee schedule,100% of APC rate,445.65,100,,,fee schedule,100% of APC rate,323.25,145,,,fee schedule,145% of CMS fee schedule,445.65,100,,,fee schedule,100% of APC rate,445.65,100,,,fee schedule,100% of APC rate,445.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534,40,,427.2,percent of total billed charges,40% of total billed charges,323.25,1068,
APLIGRAF LEG 1ST 25,5612346,CDM,761,RC,15271,HCPCS,Outpatient,,,4281.48,3425.18,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3425.18,80,,2740.14,percent of total billed charges,80% of total billed charges,1595.71,37.27,,1276.57,percent of total billed charges,37.27% of total billed charges,1595.71,37.27,,1276.57,percent of total billed charges,37.27% of total billed charges,1595.71,37.27,,1276.57,percent of total billed charges,37.27% of total billed charges,1503.59,100,,,fee schedule,100% of APC rate,1503.59,100,,,fee schedule,100% of APC rate,1503.59,100,,,fee schedule,100% of APC rate,117.52,145,,,fee schedule,145% of CMS fee schedule,1503.59,100,,,fee schedule,100% of APC rate,1503.59,100,,,fee schedule,100% of APC rate,1503.59,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1712.59,40,,1370.07,percent of total billed charges,40% of total billed charges,117.52,3425.18,
CANNULA VISCOELASTIC,5645742,CDM,270,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
APLIGRAF LEG ADD 25,5612346,CDM,761,RC,15272,HCPCS,Outpatient,,,222,177.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.75,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,40,,71.04,percent of total billed charges,40% of total billed charges,23.75,177.6,
SKN GRFT T/A/L 100SQ,5612346,CDM,761,RC,15273,HCPCS,Outpatient,,,7510.89,6008.71,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6008.71,80,,4806.97,percent of total billed charges,80% of total billed charges,2799.31,37.27,,2239.45,percent of total billed charges,37.27% of total billed charges,2799.31,37.27,,2239.45,percent of total billed charges,37.27% of total billed charges,2799.31,37.27,,2239.45,percent of total billed charges,37.27% of total billed charges,2958.02,100,,,fee schedule,100% of APC rate,2958.02,100,,,fee schedule,100% of APC rate,2958.02,100,,,fee schedule,100% of APC rate,274.46,145,,,fee schedule,145% of CMS fee schedule,2958.02,100,,,fee schedule,100% of APC rate,2958.02,100,,,fee schedule,100% of APC rate,2958.02,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3004.36,40,,2403.49,percent of total billed charges,40% of total billed charges,274.46,6008.71,
SKN GRFT T/A/L EA100,5612346,CDM,761,RC,15274,HCPCS,Outpatient,,,608,486.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,486.4,80,,389.12,percent of total billed charges,80% of total billed charges,226.6,37.27,,181.28,percent of total billed charges,37.27% of total billed charges,226.6,37.27,,181.28,percent of total billed charges,37.27% of total billed charges,226.6,37.27,,181.28,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.79,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,243.2,40,,194.56,percent of total billed charges,40% of total billed charges,62.79,486.4,
APLIGRAF FOOT 1ST 25,5612353,CDM,510,RC,15275,HCPCS,Outpatient,,,3870,3096.00,  ,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,3096,80,,2476.8,percent of total billed charges,80% of total billed charges,1442.35,37.27,,1153.88,percent of total billed charges,37.27% of total billed charges,1442.35,37.27,,1153.88,percent of total billed charges,37.27% of total billed charges,1442.35,37.27,,1153.88,percent of total billed charges,37.27% of total billed charges,1503.59,100,,,fee schedule,100% of APC rate,1503.59,100,,,fee schedule,100% of APC rate,1503.59,100,,,fee schedule,100% of APC rate,130.53,145,,,fee schedule,145% of CMS fee schedule,1503.59,100,,,fee schedule,100% of APC rate,1503.59,100,,,fee schedule,100% of APC rate,1503.59,100,,,fee schedule,100% of APC rate,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,96.04,3096,
APLIGRAF FOOT ADD 25,5612353,CDM,510,RC,15276,HCPCS,Outpatient,,,222,177.60,  ,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.18,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,35.18,177.6,
SKN GRFT F/S/E/M/F,5612353,CDM,510,RC,15277,HCPCS,Outpatient,,,3870,3096.00,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,3096,80,,2476.8,percent of total billed charges,80% of total billed charges,1442.35,37.27,,1153.88,percent of total billed charges,37.27% of total billed charges,1442.35,37.27,,1153.88,percent of total billed charges,37.27% of total billed charges,1442.35,37.27,,1153.88,percent of total billed charges,37.27% of total billed charges,1503.59,100,,,fee schedule,100% of APC rate,1503.59,100,,,fee schedule,100% of APC rate,1503.59,100,,,fee schedule,100% of APC rate,312.74,145,,,fee schedule,145% of CMS fee schedule,1503.59,100,,,fee schedule,100% of APC rate,1503.59,100,,,fee schedule,100% of APC rate,1503.59,100,,,fee schedule,100% of APC rate,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,96.04,3096,
SKN GRFT F/S/E/M/F,5612353,CDM,510,RC,15278,HCPCS,Outpatient,,,608,486.40,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,486.4,80,,389.12,percent of total billed charges,80% of total billed charges,226.6,37.27,,181.28,percent of total billed charges,37.27% of total billed charges,226.6,37.27,,181.28,percent of total billed charges,37.27% of total billed charges,226.6,37.27,,181.28,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.33,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,78.33,486.4,
FAMCYCLOVIR 500MG,6400014,CDM,250,RC,,,Outpatient,,,43.25,34.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.6,80,,27.68,percent of total billed charges,80% of total billed charges,16.12,37.27,,12.9,percent of total billed charges,37.27% of total billed charges,16.12,37.27,,12.9,percent of total billed charges,37.27% of total billed charges,16.12,37.27,,12.9,percent of total billed charges,37.27% 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,17.3,40,,13.84,percent of total billed charges,40% of total billed charges,16.12,34.6,
FALLOPIAN RING W APL,5801832,CDM,272,RC,,,Outpatient,,,612,489.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,489.6,80,,391.68,percent of total billed charges,80% of total billed charges,228.09,37.27,,182.47,percent of total billed charges,37.27% of total billed charges,228.09,37.27,,182.47,percent of total billed charges,37.27% of total billed charges,228.09,37.27,,182.47,percent of total billed charges,37.27% 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,244.8,40,,195.84,percent of total billed charges,40% of total billed charges,228.09,489.6,
TUBE TRACH 6 DCT,5801832,CDM,272,RC,,,Outpatient,,,179,143.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% 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,71.6,40,,57.28,percent of total billed charges,40% of total billed charges,66.71,143.2,
TUBE TRACH 0 PEDI,5801832,CDM,272,RC,,,Outpatient,,,161,128.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128.8,80,,103.04,percent of total billed charges,80% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% of total billed charges,60,37.27,,48,percent of total billed charges,37.27% 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,64.4,40,,51.52,percent of total billed charges,40% of total billed charges,60,128.8,
TUBE TRACH 10 CFN,5801832,CDM,272,RC,,,Outpatient,,,180,144.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,80,,115.2,percent of total billed charges,80% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% 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,72,40,,57.6,percent of total billed charges,40% of total billed charges,67.09,144,
POLY-TUSSIN DHC,6400014,CDM,250,RC,,,Outpatient,,,3.3,2.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.64,80,,2.11,percent of total billed charges,80% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% 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,1.32,40,,1.06,percent of total billed charges,40% of total billed charges,1.23,2.64,
DOPAMINE 400MG/250D5,6065130,CDM,636,RC,J1265,HCPCS,Outpatient,,,96.75,77.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.4,80,,61.92,percent of total billed charges,80% of total billed charges,36.06,37.27,,28.85,percent of total billed charges,37.27% of total billed charges,36.06,37.27,,28.85,percent of total billed charges,37.27% of total billed charges,36.06,37.27,,28.85,percent of total billed charges,37.27% 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,38.7,40,,30.96,percent of total billed charges,40% of total billed charges,36.06,77.4,
PROTEIN/CREAT RATIO,7000029,CDM,301,RC,,,Outpatient,,,77,61.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% 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,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,28.7,61.6,
MESH PROLENE 12X12,5801832,CDM,272,RC,,,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% 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,198,40,,158.4,percent of total billed charges,40% of total billed charges,184.49,396,
DESIPRAMINE 25MG TAB,5880901,CDM,637,RC,,,Outpatient,,,4.85,3.88,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.88,80,,3.1,percent of total billed charges,80% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% of total billed charges,1.81,37.27,,1.45,percent of total billed charges,37.27% 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,1.94,40,,1.55,percent of total billed charges,40% of total billed charges,1.81,3.88,
PICC LINE DECLOTTING,8400010,CDM,760,RC,36593,HCPCS,Outpatient,,,475,380.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380,80,,304,percent of total billed charges,80% of total billed charges,177.03,37.27,,141.62,percent of total billed charges,37.27% of total billed charges,177.03,37.27,,141.62,percent of total billed charges,37.27% of total billed charges,177.03,37.27,,141.62,percent of total billed charges,37.27% of total billed charges,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,44.23,145,,,fee schedule,145% of CMS fee schedule,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190,40,,152,percent of total billed charges,40% of total billed charges,44.23,380,
PICC LINE DECLOTTING,5612346,CDM,761,RC,36593,HCPCS,Outpatient,,,475,380.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380,80,,304,percent of total billed charges,80% of total billed charges,177.03,37.27,,141.62,percent of total billed charges,37.27% of total billed charges,177.03,37.27,,141.62,percent of total billed charges,37.27% of total billed charges,177.03,37.27,,141.62,percent of total billed charges,37.27% of total billed charges,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,44.23,145,,,fee schedule,145% of CMS fee schedule,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190,40,,152,percent of total billed charges,40% of total billed charges,44.23,380,
ICU PICC STERILE TEC,5612346,CDM,761,RC,36569,HCPCS,Outpatient,,,2700,2160.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2160,80,,1728,percent of total billed charges,80% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,133.08,145,,,fee schedule,145% of CMS fee schedule,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1080,40,,864,percent of total billed charges,40% of total billed charges,133.08,2160,
ER PICC STERILE TECH,8830002,CDM,450,RC,36569,HCPCS,Outpatient,,,2700,2160.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2160,80,,1728,percent of total billed charges,80% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,133.08,145,,,fee schedule,145% of CMS fee schedule,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1080,40,,864,percent of total billed charges,40% of total billed charges,133.08,2160,
MS PICC LINE INSERT,8400010,CDM,760,RC,36569,HCPCS,Outpatient,,,2700,2160.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2160,80,,1728,percent of total billed charges,80% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,133.08,145,,,fee schedule,145% of CMS fee schedule,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1080,40,,864,percent of total billed charges,40% of total billed charges,133.08,2160,
ACTICOAT FLEX 4 X 4,5801832,CDM,272,RC,,,Outpatient,,,102,81.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.6,80,,65.28,percent of total billed charges,80% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% of total billed charges,38.02,37.27,,30.42,percent of total billed charges,37.27% 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,40.8,40,,32.64,percent of total billed charges,40% of total billed charges,38.02,81.6,
ALLEVYN THIN 4 X 4,5801832,CDM,272,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
AQUACEL AG 2 X 2,5801832,CDM,272,RC,,,Outpatient,,,10,8.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,80,,6.4,percent of total billed charges,80% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% of total billed charges,3.73,37.27,,2.98,percent of total billed charges,37.27% 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,4,40,,3.2,percent of total billed charges,40% of total billed charges,3.73,8,
CALCIUM ALGINATE 2X2,5801832,CDM,272,RC,,,Outpatient,,,13,10.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.4,80,,8.32,percent of total billed charges,80% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% of total billed charges,4.85,37.27,,3.88,percent of total billed charges,37.27% 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,5.2,40,,4.16,percent of total billed charges,40% of total billed charges,4.85,10.4,
CALCIUM ALGINATE 4X4,5801832,CDM,272,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
FIBRACOL 4X4 3/8,5801832,CDM,272,RC,,,Outpatient,,,83,66.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% 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,33.2,40,,26.56,percent of total billed charges,40% of total billed charges,30.93,66.4,
MEPILEX BORDER 4X4,5801832,CDM,272,RC,,,Outpatient,,,17,13.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.6,80,,10.88,percent of total billed charges,80% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% of total billed charges,6.34,37.27,,5.07,percent of total billed charges,37.27% 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,6.8,40,,5.44,percent of total billed charges,40% of total billed charges,6.34,13.6,
MEPILEX BORDER 6X6,5801832,CDM,272,RC,,,Outpatient,,,27,21.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.6,80,,17.28,percent of total billed charges,80% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% of total billed charges,10.06,37.27,,8.05,percent of total billed charges,37.27% 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,10.8,40,,8.64,percent of total billed charges,40% of total billed charges,10.06,21.6,
MEPITEL ONE 2 X 3,5801832,CDM,272,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
MEPITEL ONE 3 X 4,5801832,CDM,272,RC,,,Outpatient,,,30,24.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% 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,12,40,,9.6,percent of total billed charges,40% of total billed charges,11.18,24,
PROMOGRAN 4.34 SQ IN,5801832,CDM,272,RC,Q4100,HCPCS,Outpatient,,,67,53.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% 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,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,24.97,53.6,
SORBION SACHET 4X4,5801832,CDM,272,RC,,,Outpatient,,,55,44.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% 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,22,40,,17.6,percent of total billed charges,40% of total billed charges,20.5,44,
SORBION SACHET 8X4,5801832,CDM,272,RC,,,Outpatient,,,121,96.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% 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,48.4,40,,38.72,percent of total billed charges,40% of total billed charges,45.1,96.8,
TIELLE 4X4,5801832,CDM,272,RC,,,Outpatient,,,40,32.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% 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,16,40,,12.8,percent of total billed charges,40% of total billed charges,14.91,32,
VIGILON 4 X 4,5801832,CDM,272,RC,,,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% 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,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,14.54,31.2,
"FIBRACOL 2 X 2""",5801832,CDM,272,RC,,,Outpatient,,,33,26.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% 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,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,12.3,26.4,
PITOCIN 10UN/ML MDV,5880901,CDM,637,RC,J2590,HCPCS,Outpatient,,,15.45,12.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.36,80,,9.89,percent of total billed charges,80% of total billed charges,5.76,37.27,,4.61,percent of total billed charges,37.27% of total billed charges,5.76,37.27,,4.61,percent of total billed charges,37.27% of total billed charges,5.76,37.27,,4.61,percent of total billed charges,37.27% 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,6.18,40,,4.94,percent of total billed charges,40% of total billed charges,5.76,12.36,
ONDANSETRON 2MG/ML,5880901,CDM,637,RC,J2405,HCPCS,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
HOLTER SCANNING,7650120,CDM,731,RC,93226,HCPCS,Outpatient,,,281,224.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.8,80,,179.84,percent of total billed charges,80% of total billed charges,104.73,37.27,,83.78,percent of total billed charges,37.27% of total billed charges,104.73,37.27,,83.78,percent of total billed charges,37.27% of total billed charges,104.73,37.27,,83.78,percent of total billed charges,37.27% of total billed charges,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,45.37,145,,,fee schedule,145% of CMS fee schedule,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112.4,40,,89.92,percent of total billed charges,40% of total billed charges,45.37,224.8,
SUFENTA 50MCG/ML 1ML,6065130,CDM,636,RC,,,Outpatient,,,18.35,14.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.68,80,,11.74,percent of total billed charges,80% of total billed charges,6.84,37.27,,5.47,percent of total billed charges,37.27% of total billed charges,6.84,37.27,,5.47,percent of total billed charges,37.27% of total billed charges,6.84,37.27,,5.47,percent of total billed charges,37.27% 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,7.34,40,,5.87,percent of total billed charges,40% of total billed charges,6.84,14.68,
SUFENTA 50MCG/ML 2ML,6065130,CDM,636,RC,J3010,HCPCS,Outpatient,,,31,24.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% 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,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,11.55,24.8,
PRAZOSIN 2MG CAP,6400014,CDM,250,RC,,,Outpatient,,,4.5,3.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.6,80,,2.88,percent of total billed charges,80% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% of total billed charges,1.68,37.27,,1.34,percent of total billed charges,37.27% 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,1.8,40,,1.44,percent of total billed charges,40% of total billed charges,1.68,3.6,
ELUTION PREP,7000169,CDM,302,RC,86860,HCPCS,Outpatient,,,168,134.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,67.2,40,,53.76,percent of total billed charges,40% of total billed charges,62.61,140.82,
HYDROCODONE,7000029,CDM,301,RC,80361,HCPCS,Outpatient,,,217,173.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,80.88,37.27,,64.7,percent of total billed charges,37.27% of total billed charges,80.88,37.27,,64.7,percent of total billed charges,37.27% of total billed charges,80.88,37.27,,64.7,percent of total billed charges,37.27% 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,86.8,40,,69.44,percent of total billed charges,40% of total billed charges,80.88,173.6,
SYNTHETIC MARIJUANA,7000029,CDM,301,RC,80352,HCPCS,Outpatient,,,193,154.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.4,80,,123.52,percent of total billed charges,80% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% 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,77.2,40,,61.76,percent of total billed charges,40% of total billed charges,71.93,154.4,
PHENOTYPE,7000169,CDM,302,RC,86905,HCPCS,Outpatient,,,693,554.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,554.4,80,,443.52,percent of total billed charges,80% of total billed charges,258.28,37.27,,206.62,percent of total billed charges,37.27% of total billed charges,258.28,37.27,,206.62,percent of total billed charges,37.27% of total billed charges,258.28,37.27,,206.62,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,3.83,100,,,fee schedule,100% of CMS fee schedule,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.2,40,,221.76,percent of total billed charges,40% of total billed charges,3.83,554.4,
PENTAM 300MG INJ,6065130,CDM,636,RC,S0080,HCPCS,Outpatient,,,336.75,269.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,269.4,80,,215.52,percent of total billed charges,80% of total billed charges,125.51,37.27,,100.41,percent of total billed charges,37.27% of total billed charges,125.51,37.27,,100.41,percent of total billed charges,37.27% of total billed charges,125.51,37.27,,100.41,percent of total billed charges,37.27% 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,134.7,40,,107.76,percent of total billed charges,40% of total billed charges,125.51,269.4,
ANASTROZOLE 1MG TAB,6400014,CDM,250,RC,,,Outpatient,,,45.5,36.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.4,80,,29.12,percent of total billed charges,80% of total billed charges,16.96,37.27,,13.57,percent of total billed charges,37.27% of total billed charges,16.96,37.27,,13.57,percent of total billed charges,37.27% of total billed charges,16.96,37.27,,13.57,percent of total billed charges,37.27% 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,18.2,40,,14.56,percent of total billed charges,40% of total billed charges,16.96,36.4,
EPINEPHRINE SULF FRE,5880901,CDM,637,RC,J0171,HCPCS,Outpatient,,,1.43,1.14,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.14,80,,0.91,percent of total billed charges,80% of total billed charges,0.53,37.27,,0.42,percent of total billed charges,37.27% of total billed charges,0.53,37.27,,0.42,percent of total billed charges,37.27% of total billed charges,0.53,37.27,,0.42,percent of total billed charges,37.27% 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,0.57,40,,0.46,percent of total billed charges,40% of total billed charges,0.53,1.14,
TAMIFLU SUSP 6MG/ML,5880901,CDM,637,RC,,,Outpatient,,,565,452.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,452,80,,361.6,percent of total billed charges,80% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% of total billed charges,210.58,37.27,,168.46,percent of total billed charges,37.27% 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,226,40,,180.8,percent of total billed charges,40% of total billed charges,210.58,452,
CT CERVICAL SP WOW,6010052,CDM,350,RC,72127,HCPCS,Outpatient,,,2399,1919.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1919.2,80,,1535.36,percent of total billed charges,80% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,182.06,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,959.6,40,,767.68,percent of total billed charges,40% of total billed charges,151.49,1919.2,
CHLOR DIAZEPOXIDE,7000029,CDM,301,RC,80346,HCPCS,Outpatient,,,280,224.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224,80,,179.2,percent of total billed charges,80% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% 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,112,40,,89.6,percent of total billed charges,40% of total billed charges,104.36,224,
DROXIA 400MG CAP,5880901,CDM,637,RC,,,Outpatient,,,3.3,2.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.64,80,,2.11,percent of total billed charges,80% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% of total billed charges,1.23,37.27,,0.98,percent of total billed charges,37.27% 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,1.32,40,,1.06,percent of total billed charges,40% of total billed charges,1.23,2.64,
CLEMASTINE 2.68MG,6400014,CDM,250,RC,,,Outpatient,,,2.95,2.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,80,,1.89,percent of total billed charges,80% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% 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,1.18,40,,0.94,percent of total billed charges,40% of total billed charges,1.1,2.36,
APPLIC UNNA BOOT LT,5612346,CDM,761,RC,29580,HCPCS,Outpatient,,,375.3,300.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300.24,80,,240.19,percent of total billed charges,80% of total billed charges,139.87,37.27,,111.9,percent of total billed charges,37.27% of total billed charges,139.87,37.27,,111.9,percent of total billed charges,37.27% of total billed charges,139.87,37.27,,111.9,percent of total billed charges,37.27% of total billed charges,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,37.16,145,,,fee schedule,145% of CMS fee schedule,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.12,40,,120.1,percent of total billed charges,40% of total billed charges,37.16,300.24,
APPLIC COMPR BELOW L,5612353,CDM,510,RC,29581,HCPCS,Outpatient,,,375.3,300.24,LT,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,300.24,80,,240.19,percent of total billed charges,80% of total billed charges,139.87,37.27,,111.9,percent of total billed charges,37.27% of total billed charges,139.87,37.27,,111.9,percent of total billed charges,37.27% of total billed charges,139.87,37.27,,111.9,percent of total billed charges,37.27% of total billed charges,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,37.12,145,,,fee schedule,145% of CMS fee schedule,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,37.12,300.24,
LAP BAND,8605396,CDM,278,RC,,,Outpatient,,,4884,3907.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907.2,80,,3125.76,percent of total billed charges,80% of total billed charges,1820.27,37.27,,1456.22,percent of total billed charges,37.27% of total billed charges,1820.27,37.27,,1456.22,percent of total billed charges,37.27% of total billed charges,1820.27,37.27,,1456.22,percent of total billed charges,37.27% 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,1953.6,40,,1562.88,percent of total billed charges,40% of total billed charges,1820.27,3907.2,
TK QUICK LOAD,5801832,CDM,272,RC,,,Outpatient,,,204,163.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% 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,81.6,40,,65.28,percent of total billed charges,40% of total billed charges,76.03,163.2,
TK TI-KNOT DEVICE,5801832,CDM,272,RC,,,Outpatient,,,536,428.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428.8,80,,343.04,percent of total billed charges,80% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% 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,214.4,40,,171.52,percent of total billed charges,40% of total billed charges,199.77,428.8,
RAPIDPORT EZ LAP BAN,5801832,CDM,272,RC,,,Outpatient,,,2085,1668.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1668,80,,1334.4,percent of total billed charges,80% of total billed charges,777.08,37.27,,621.66,percent of total billed charges,37.27% of total billed charges,777.08,37.27,,621.66,percent of total billed charges,37.27% of total billed charges,777.08,37.27,,621.66,percent of total billed charges,37.27% 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,834,40,,667.2,percent of total billed charges,40% of total billed charges,777.08,1668,
TROCAR 15MM ETH,5801832,CDM,272,RC,,,Outpatient,,,530,424.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,424,80,,339.2,percent of total billed charges,80% of total billed charges,197.53,37.27,,158.02,percent of total billed charges,37.27% of total billed charges,197.53,37.27,,158.02,percent of total billed charges,37.27% of total billed charges,197.53,37.27,,158.02,percent of total billed charges,37.27% 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,212,40,,169.6,percent of total billed charges,40% of total billed charges,197.53,424,
CT THORACIC SP W/WO,6010052,CDM,350,RC,72130,HCPCS,Outpatient,,,2399,1919.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1919.2,80,,1535.36,percent of total billed charges,80% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,183.34,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,959.6,40,,767.68,percent of total billed charges,40% of total billed charges,151.49,1919.2,
OSS PROC LVL 1,5612346,CDM,761,RC,SURG,HCPCS,Outpatient,,,554,443.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% 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,221.6,40,,177.28,percent of total billed charges,40% of total billed charges,206.48,443.2,
OSS PROC LVL 2,5612346,CDM,761,RC,SURG,HCPCS,Outpatient,,,1555,1244.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1244,80,,995.2,percent of total billed charges,80% of total billed charges,579.55,37.27,,463.64,percent of total billed charges,37.27% of total billed charges,579.55,37.27,,463.64,percent of total billed charges,37.27% of total billed charges,579.55,37.27,,463.64,percent of total billed charges,37.27% 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,622,40,,497.6,percent of total billed charges,40% of total billed charges,579.55,1244,
OSS PROC LVL 3,5612346,CDM,761,RC,SURG,HCPCS,Outpatient,,,2307,1845.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1845.6,80,,1476.48,percent of total billed charges,80% of total billed charges,859.82,37.27,,687.86,percent of total billed charges,37.27% of total billed charges,859.82,37.27,,687.86,percent of total billed charges,37.27% of total billed charges,859.82,37.27,,687.86,percent of total billed charges,37.27% 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,922.8,40,,738.24,percent of total billed charges,40% of total billed charges,859.82,1845.6,
OSS PROC LVL 4,5612346,CDM,761,RC,SURG,HCPCS,Outpatient,,,5192,4153.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4153.6,80,,3322.88,percent of total billed charges,80% of total billed charges,1935.06,37.27,,1548.05,percent of total billed charges,37.27% of total billed charges,1935.06,37.27,,1548.05,percent of total billed charges,37.27% of total billed charges,1935.06,37.27,,1548.05,percent of total billed charges,37.27% 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,2076.8,40,,1661.44,percent of total billed charges,40% of total billed charges,1935.06,4153.6,
"CT,NG,TRICH VAG-NAA",7000029,CDM,301,RC,,,Outpatient,,,315.28,252.22,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.22,80,,201.78,percent of total billed charges,80% of total billed charges,117.5,37.27,,94,percent of total billed charges,37.27% of total billed charges,117.5,37.27,,94,percent of total billed charges,37.27% of total billed charges,117.5,37.27,,94,percent of total billed charges,37.27% 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,126.11,40,,100.89,percent of total billed charges,40% of total billed charges,117.5,252.22,
"CG/CHLY/TRIC/HSV 1,2",7000029,CDM,301,RC,,,Outpatient,,,687.28,549.82,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,549.82,80,,439.86,percent of total billed charges,80% of total billed charges,256.15,37.27,,204.92,percent of total billed charges,37.27% of total billed charges,256.15,37.27,,204.92,percent of total billed charges,37.27% of total billed charges,256.15,37.27,,204.92,percent of total billed charges,37.27% 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,274.91,40,,219.93,percent of total billed charges,40% of total billed charges,256.15,549.82,
BACTERIAL VAGINOSIS+,7000029,CDM,301,RC,,,Outpatient,,,1272.28,1017.82,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1017.82,80,,814.26,percent of total billed charges,80% of total billed charges,474.18,37.27,,379.34,percent of total billed charges,37.27% of total billed charges,474.18,37.27,,379.34,percent of total billed charges,37.27% of total billed charges,474.18,37.27,,379.34,percent of total billed charges,37.27% 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,508.91,40,,407.13,percent of total billed charges,40% of total billed charges,474.18,1017.82,
NUSWAB BV & CAN NAA,7000029,CDM,301,RC,,,Outpatient,,,957,765.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,765.6,80,,612.48,percent of total billed charges,80% of total billed charges,356.67,37.27,,285.34,percent of total billed charges,37.27% of total billed charges,356.67,37.27,,285.34,percent of total billed charges,37.27% of total billed charges,356.67,37.27,,285.34,percent of total billed charges,37.27% 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,382.8,40,,306.24,percent of total billed charges,40% of total billed charges,356.67,765.6,
CG/CHLY LB CRP183194,7012032,CDM,300,RC,,,Outpatient,,,195.28,156.22,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.22,80,,124.98,percent of total billed charges,80% of total billed charges,72.78,37.27,,58.22,percent of total billed charges,37.27% of total billed charges,72.78,37.27,,58.22,percent of total billed charges,37.27% of total billed charges,72.78,37.27,,58.22,percent of total billed charges,37.27% 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,78.11,40,,62.49,percent of total billed charges,40% of total billed charges,72.78,156.22,
BACTERIAL VAG#180039,7000029,CDM,301,RC,,,Outpatient,,,1154,923.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,923.2,80,,738.56,percent of total billed charges,80% of total billed charges,430.1,37.27,,344.08,percent of total billed charges,37.27% of total billed charges,430.1,37.27,,344.08,percent of total billed charges,37.27% of total billed charges,430.1,37.27,,344.08,percent of total billed charges,37.27% 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,461.6,40,,369.28,percent of total billed charges,40% of total billed charges,430.1,923.2,
FENTANYL MDV 50ML,6400014,CDM,250,RC,,,Outpatient,,,39.3,31.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.44,80,,25.15,percent of total billed charges,80% of total billed charges,14.65,37.27,,11.72,percent of total billed charges,37.27% of total billed charges,14.65,37.27,,11.72,percent of total billed charges,37.27% of total billed charges,14.65,37.27,,11.72,percent of total billed charges,37.27% 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,15.72,40,,12.58,percent of total billed charges,40% of total billed charges,14.65,31.44,
ZINC 50MG TAB (CHEL),6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
KIDNEY STONE URNE/SA,7012032,CDM,300,RC,,,Outpatient,,,806,644.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,644.8,80,,515.84,percent of total billed charges,80% of total billed charges,300.4,37.27,,240.32,percent of total billed charges,37.27% of total billed charges,300.4,37.27,,240.32,percent of total billed charges,37.27% of total billed charges,300.4,37.27,,240.32,percent of total billed charges,37.27% 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,322.4,40,,257.92,percent of total billed charges,40% of total billed charges,300.4,644.8,
LANSOPRAZOL 15MG STB,6400014,CDM,250,RC,,,Outpatient,,,20.1,16.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.08,80,,12.86,percent of total billed charges,80% of total billed charges,7.49,37.27,,5.99,percent of total billed charges,37.27% of total billed charges,7.49,37.27,,5.99,percent of total billed charges,37.27% of total billed charges,7.49,37.27,,5.99,percent of total billed charges,37.27% 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,8.04,40,,6.43,percent of total billed charges,40% of total billed charges,7.49,16.08,
CT LUMBAR SP WOW,6010052,CDM,350,RC,72133,HCPCS,Outpatient,,,2399,1919.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1919.2,80,,1535.36,percent of total billed charges,80% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,182.48,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,959.6,40,,767.68,percent of total billed charges,40% of total billed charges,151.49,1919.2,
CT SELLA/IAC/ORB/WOW,6010052,CDM,350,RC,70482,HCPCS,Outpatient,,,2399,1919.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1919.2,80,,1535.36,percent of total billed charges,80% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,199.4,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,959.6,40,,767.68,percent of total billed charges,40% of total billed charges,151.49,1919.2,
ZINC 50MG CAPLET,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
EZ-10 25 MM NEEDLE,5801832,CDM,272,RC,,,Outpatient,,,212,169.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,169.6,80,,135.68,percent of total billed charges,80% of total billed charges,79.01,37.27,,63.21,percent of total billed charges,37.27% of total billed charges,79.01,37.27,,63.21,percent of total billed charges,37.27% of total billed charges,79.01,37.27,,63.21,percent of total billed charges,37.27% 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,84.8,40,,67.84,percent of total billed charges,40% of total billed charges,79.01,169.6,
XGEVA 120MG INJ,6065130,CDM,636,RC,J0897,HCPCS,Outpatient,,,47.13,37.70,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.7,80,,30.16,percent of total billed charges,80% of total billed charges,17.57,37.27,,14.06,percent of total billed charges,37.27% of total billed charges,17.57,37.27,,14.06,percent of total billed charges,37.27% of total billed charges,17.57,37.27,,14.06,percent of total billed charges,37.27% of total billed charges,26.96,100,,,fee schedule,100% of APC rate,26.96,100,,,fee schedule,100% of APC rate,26.96,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,26.96,100,,,fee schedule,100% of APC rate,26.96,100,,,fee schedule,100% of APC rate,26.96,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.85,40,,15.08,percent of total billed charges,40% of total billed charges,17.57,37.7,
ROOM HUMIDIFIER,5801832,CDM,272,RC,,,Outpatient,,,134,107.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% 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,53.6,40,,42.88,percent of total billed charges,40% of total billed charges,49.94,107.2,
POLYMYXIN B 500000UN,6065130,CDM,636,RC,J3490,HCPCS,Outpatient,,,46.55,37.24,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.24,80,,29.79,percent of total billed charges,80% of total billed charges,17.35,37.27,,13.88,percent of total billed charges,37.27% of total billed charges,17.35,37.27,,13.88,percent of total billed charges,37.27% of total billed charges,17.35,37.27,,13.88,percent of total billed charges,37.27% 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,18.62,40,,14.9,percent of total billed charges,40% of total billed charges,17.35,37.24,
SURGIDEC SUTURE 18CM,5801832,CDM,272,RC,,,Outpatient,,,560,448.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,448,80,,358.4,percent of total billed charges,80% of total billed charges,208.71,37.27,,166.97,percent of total billed charges,37.27% of total billed charges,208.71,37.27,,166.97,percent of total billed charges,37.27% of total billed charges,208.71,37.27,,166.97,percent of total billed charges,37.27% 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,224,40,,179.2,percent of total billed charges,40% of total billed charges,208.71,448,
ENDOSTITCH DEVICE,5801832,CDM,272,RC,,,Outpatient,,,873,698.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,698.4,80,,558.72,percent of total billed charges,80% of total billed charges,325.37,37.27,,260.3,percent of total billed charges,37.27% of total billed charges,325.37,37.27,,260.3,percent of total billed charges,37.27% of total billed charges,325.37,37.27,,260.3,percent of total billed charges,37.27% 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,349.2,40,,279.36,percent of total billed charges,40% of total billed charges,325.37,698.4,
XZRELTO 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,42.9,34.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.32,80,,27.46,percent of total billed charges,80% of total billed charges,15.99,37.27,,12.79,percent of total billed charges,37.27% of total billed charges,15.99,37.27,,12.79,percent of total billed charges,37.27% of total billed charges,15.99,37.27,,12.79,percent of total billed charges,37.27% 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,17.16,40,,13.73,percent of total billed charges,40% of total billed charges,15.99,34.32,
DEXILANT 30MG CAP,5880901,CDM,637,RC,,,Outpatient,,,42.05,33.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.64,80,,26.91,percent of total billed charges,80% of total billed charges,15.67,37.27,,12.54,percent of total billed charges,37.27% of total billed charges,15.67,37.27,,12.54,percent of total billed charges,37.27% of total billed charges,15.67,37.27,,12.54,percent of total billed charges,37.27% 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,16.82,40,,13.46,percent of total billed charges,40% of total billed charges,15.67,33.64,
TROCAR 11X150 CTF31,5801832,CDM,272,RC,,,Outpatient,,,230,184.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184,80,,147.2,percent of total billed charges,80% of total billed charges,85.72,37.27,,68.58,percent of total billed charges,37.27% of total billed charges,85.72,37.27,,68.58,percent of total billed charges,37.27% of total billed charges,85.72,37.27,,68.58,percent of total billed charges,37.27% 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,92,40,,73.6,percent of total billed charges,40% of total billed charges,85.72,184,
ACETADOTE 100MG X 60,6065130,CDM,636,RC,J0132,HCPCS,Outpatient,,,12.35,9.88,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.88,80,,7.9,percent of total billed charges,80% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% of total billed charges,4.6,37.27,,3.68,percent of total billed charges,37.27% 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,4.94,40,,3.95,percent of total billed charges,40% of total billed charges,4.6,9.88,
XARELTO 10MG TAB,5880901,CDM,637,RC,,,Outpatient,,,77.65,62.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.12,80,,49.7,percent of total billed charges,80% of total billed charges,28.94,37.27,,23.15,percent of total billed charges,37.27% of total billed charges,28.94,37.27,,23.15,percent of total billed charges,37.27% of total billed charges,28.94,37.27,,23.15,percent of total billed charges,37.27% 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,31.06,40,,24.85,percent of total billed charges,40% of total billed charges,28.94,62.12,
UROQUID ACID,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
OSS MIDLINE INSERT,5612346,CDM,761,RC,36410,HCPCS,Outpatient,,,2400,1920.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1920,80,,1536,percent of total billed charges,80% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.75,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,40,,768,percent of total billed charges,40% of total billed charges,12.75,1920,
VACCINE ADMIN EA ADD,9397936,CDM,771,RC,90472,HCPCS,Outpatient,,,73,58.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.62,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,19.62,58.4,
RACEPINEPHRINE (S2),6400014,CDM,250,RC,,,Outpatient,,,8.5,6.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.8,80,,5.44,percent of total billed charges,80% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% of total billed charges,3.17,37.27,,2.54,percent of total billed charges,37.27% 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,3.4,40,,2.72,percent of total billed charges,40% of total billed charges,3.17,6.8,
ALDOSTERONE RENIN RA,7000029,CDM,301,RC,,,Outpatient,,,409,327.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,327.2,80,,261.76,percent of total billed charges,80% of total billed charges,152.43,37.27,,121.94,percent of total billed charges,37.27% of total billed charges,152.43,37.27,,121.94,percent of total billed charges,37.27% of total billed charges,152.43,37.27,,121.94,percent of total billed charges,37.27% 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,163.6,40,,130.88,percent of total billed charges,40% of total billed charges,152.43,327.2,
T CELL PROFILE,7000029,CDM,301,RC,,,Outpatient,,,819,655.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,655.2,80,,524.16,percent of total billed charges,80% of total billed charges,305.24,37.27,,244.19,percent of total billed charges,37.27% of total billed charges,305.24,37.27,,244.19,percent of total billed charges,37.27% of total billed charges,305.24,37.27,,244.19,percent of total billed charges,37.27% 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,327.6,40,,262.08,percent of total billed charges,40% of total billed charges,305.24,655.2,
SURG PATH MIRCEX LV3,7012032,CDM,300,RC,88304,HCPCS,Outpatient,,,207,165.60,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165.6,80,,132.48,percent of total billed charges,80% of total billed charges,77.15,37.27,,61.72,percent of total billed charges,37.27% of total billed charges,77.15,37.27,,61.72,percent of total billed charges,37.27% of total billed charges,77.15,37.27,,61.72,percent of total billed charges,37.27% of total billed charges,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,40.72,145,,,fee schedule,145% of CMS fee schedule,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.8,40,,66.24,percent of total billed charges,40% of total billed charges,40.72,165.6,
SURG PATH MIRCEX LV4,7012032,CDM,300,RC,88305,HCPCS,Outpatient,,,269,215.20,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,215.2,80,,172.16,percent of total billed charges,80% of total billed charges,100.26,37.27,,80.21,percent of total billed charges,37.27% of total billed charges,100.26,37.27,,80.21,percent of total billed charges,37.27% of total billed charges,100.26,37.27,,80.21,percent of total billed charges,37.27% of total billed charges,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,45.37,145,,,fee schedule,145% of CMS fee schedule,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.6,40,,86.08,percent of total billed charges,40% of total billed charges,44.67,215.2,
SURG PATH MIRCEX LV5,7012032,CDM,300,RC,88307,HCPCS,Outpatient,,,419,335.20,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,335.2,80,,268.16,percent of total billed charges,80% of total billed charges,156.16,37.27,,124.93,percent of total billed charges,37.27% of total billed charges,156.16,37.27,,124.93,percent of total billed charges,37.27% of total billed charges,156.16,37.27,,124.93,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,265.61,145,,,fee schedule,145% of CMS fee schedule,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,167.6,40,,134.08,percent of total billed charges,40% of total billed charges,156.16,335.2,
SURG PATH MIRCEX LV6,7012032,CDM,300,RC,88309,HCPCS,Outpatient,,,574,459.20,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,459.2,80,,367.36,percent of total billed charges,80% of total billed charges,213.93,37.27,,171.14,percent of total billed charges,37.27% of total billed charges,213.93,37.27,,171.14,percent of total billed charges,37.27% of total billed charges,213.93,37.27,,171.14,percent of total billed charges,37.27% of total billed charges,708.98,100,,,fee schedule,100% of APC rate,708.98,100,,,fee schedule,100% of APC rate,708.98,100,,,fee schedule,100% of APC rate,372.59,145,,,fee schedule,145% of CMS fee schedule,708.98,100,,,fee schedule,100% of APC rate,708.98,100,,,fee schedule,100% of APC rate,708.98,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,229.6,40,,183.68,percent of total billed charges,40% of total billed charges,213.93,708.98,
DECALCIFY TISSUE,7012032,CDM,300,RC,88311,HCPCS,Outpatient,,,22,17.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.12,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,8.2,17.6,
SPECIAL STAINS GRP 1,7012032,CDM,300,RC,88312,HCPCS,Outpatient,,,214,171.20,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.2,80,,136.96,percent of total billed charges,80% of total billed charges,79.76,37.27,,63.81,percent of total billed charges,37.27% of total billed charges,79.76,37.27,,63.81,percent of total billed charges,37.27% of total billed charges,79.76,37.27,,63.81,percent of total billed charges,37.27% of total billed charges,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,110.48,145,,,fee schedule,145% of CMS fee schedule,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,85.6,40,,68.48,percent of total billed charges,40% of total billed charges,44.67,171.2,
SPECIAL STAINS GRP 2,7012032,CDM,300,RC,88313,HCPCS,Outpatient,,,192,153.60,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.6,80,,122.88,percent of total billed charges,80% of total billed charges,71.56,37.27,,57.25,percent of total billed charges,37.27% of total billed charges,71.56,37.27,,57.25,percent of total billed charges,37.27% of total billed charges,71.56,37.27,,57.25,percent of total billed charges,37.27% of total billed charges,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,90.61,145,,,fee schedule,145% of CMS fee schedule,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,40,,61.44,percent of total billed charges,40% of total billed charges,50.43,153.6,
ENZYME HISTOCHEM GP3,7012032,CDM,300,RC,88319,HCPCS,Outpatient,,,1081.92,865.54,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,865.54,80,,692.43,percent of total billed charges,80% of total billed charges,403.23,37.27,,322.58,percent of total billed charges,37.27% of total billed charges,403.23,37.27,,322.58,percent of total billed charges,37.27% of total billed charges,403.23,37.27,,322.58,percent of total billed charges,37.27% of total billed charges,708.98,100,,,fee schedule,100% of APC rate,708.98,100,,,fee schedule,100% of APC rate,708.98,100,,,fee schedule,100% of APC rate,140.62,145,,,fee schedule,145% of CMS fee schedule,708.98,100,,,fee schedule,100% of APC rate,708.98,100,,,fee schedule,100% of APC rate,708.98,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,432.77,40,,346.22,percent of total billed charges,40% of total billed charges,140.62,865.54,
MICROSLIDE CONSULT,7012032,CDM,300,RC,88323,HCPCS,Outpatient,,,203,162.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,37.76,145,,,fee schedule,145% of CMS fee schedule,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.2,40,,64.96,percent of total billed charges,40% of total billed charges,37.76,162.4,
PATH CONSULT INOP 1B,7012032,CDM,300,RC,88331,HCPCS,Outpatient,,,258.36,206.69,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,206.69,80,,165.35,percent of total billed charges,80% of total billed charges,96.29,37.27,,77.03,percent of total billed charges,37.27% of total billed charges,96.29,37.27,,77.03,percent of total billed charges,37.27% of total billed charges,96.29,37.27,,77.03,percent of total billed charges,37.27% of total billed charges,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,52.55,145,,,fee schedule,145% of CMS fee schedule,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.34,40,,82.67,percent of total billed charges,40% of total billed charges,52.55,206.69,
PATH CONSULT INOP A1,7012032,CDM,300,RC,88332,HCPCS,Outpatient,,,39,31.20,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.83,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,14.54,31.83,
INTRAOP CYTO PTH CO1,7012032,CDM,300,RC,88333,HCPCS,Outpatient,,,1081.92,865.54,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,865.54,80,,692.43,percent of total billed charges,80% of total billed charges,403.23,37.27,,322.58,percent of total billed charges,37.27% of total billed charges,403.23,37.27,,322.58,percent of total billed charges,37.27% of total billed charges,403.23,37.27,,322.58,percent of total billed charges,37.27% of total billed charges,708.98,100,,,fee schedule,100% of APC rate,708.98,100,,,fee schedule,100% of APC rate,708.98,100,,,fee schedule,100% of APC rate,40.72,145,,,fee schedule,145% of CMS fee schedule,708.98,100,,,fee schedule,100% of APC rate,708.98,100,,,fee schedule,100% of APC rate,708.98,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,432.77,40,,346.22,percent of total billed charges,40% of total billed charges,40.72,865.54,
INTRAOP CYTO PT CON2,7012032,CDM,300,RC,88334,HCPCS,Outpatient,,,43,34.40,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.4,80,,27.52,percent of total billed charges,80% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,16.03,37.27,,12.82,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.52,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.2,40,,13.76,percent of total billed charges,40% of total billed charges,16.03,34.4,
IMMUNOHISTOCHEMISTRY,7000268,CDM,310,RC,88342,HCPCS,Outpatient,,,430.86,344.69,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344.69,80,,275.75,percent of total billed charges,80% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,91.87,145,,,fee schedule,145% of CMS fee schedule,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.34,40,,137.87,percent of total billed charges,40% of total billed charges,91.87,344.69,
SUTURE 683G,5801832,CDM,272,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
SUTURE 684G,5801832,CDM,272,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
ENOXAPARIN 300MG/3ML,6065130,CDM,636,RC,J1650,HCPCS,Outpatient,,,30.8,24.64,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.64,80,,19.71,percent of total billed charges,80% of total billed charges,11.48,37.27,,9.18,percent of total billed charges,37.27% of total billed charges,11.48,37.27,,9.18,percent of total billed charges,37.27% of total billed charges,11.48,37.27,,9.18,percent of total billed charges,37.27% 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,12.32,40,,9.86,percent of total billed charges,40% of total billed charges,11.48,24.64,
DRESSING TENDER WET,5645742,CDM,270,RC,,,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% 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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,12,
HYDROMORPHONE 10MG/M,6065130,CDM,636,RC,J1170,HCPCS,Outpatient,,,13.1,10.48,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.48,80,,8.38,percent of total billed charges,80% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% 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,5.24,40,,4.19,percent of total billed charges,40% of total billed charges,4.88,10.48,
MORPHINE 20MG/ML SOL,5880901,CDM,637,RC,,,Outpatient,,,85.95,68.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.76,80,,55.01,percent of total billed charges,80% of total billed charges,32.03,37.27,,25.62,percent of total billed charges,37.27% of total billed charges,32.03,37.27,,25.62,percent of total billed charges,37.27% of total billed charges,32.03,37.27,,25.62,percent of total billed charges,37.27% 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,34.38,40,,27.5,percent of total billed charges,40% of total billed charges,32.03,68.76,
NEUDEXTA 20/10MG,6400014,CDM,250,RC,,,Outpatient,,,97.55,78.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.04,80,,62.43,percent of total billed charges,80% of total billed charges,36.36,37.27,,29.09,percent of total billed charges,37.27% of total billed charges,36.36,37.27,,29.09,percent of total billed charges,37.27% of total billed charges,36.36,37.27,,29.09,percent of total billed charges,37.27% 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,39.02,40,,31.22,percent of total billed charges,40% of total billed charges,36.36,78.04,
FLOW CYTOMETRY EA AD,7012032,CDM,300,RC,88185,HCPCS,Outpatient,,,109,87.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.02,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,43.6,40,,34.88,percent of total billed charges,40% of total billed charges,30.02,87.2,
CYTOPATHOLOGY SEL CE,7012032,CDM,300,RC,88112,HCPCS,Outpatient,,,244,195.20,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,195.2,80,,156.16,percent of total billed charges,80% of total billed charges,90.94,37.27,,72.75,percent of total billed charges,37.27% of total billed charges,90.94,37.27,,72.75,percent of total billed charges,37.27% of total billed charges,90.94,37.27,,72.75,percent of total billed charges,37.27% of total billed charges,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,52.55,145,,,fee schedule,145% of CMS fee schedule,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.6,40,,78.08,percent of total billed charges,40% of total billed charges,44.67,195.2,
DELIVER PLACENTA ONL,,,720,RC,59414,HCPCS,Outpatient,,,5000,4000.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4000,80,,3200,percent of total billed charges,80% of total billed charges,1863.5,37.27,,1490.8,percent of total billed charges,37.27% of total billed charges,1863.5,37.27,,1490.8,percent of total billed charges,37.27% of total billed charges,1863.5,37.27,,1490.8,percent of total billed charges,37.27% of total billed charges,2577.69,100,,,fee schedule,100% of APC rate,2577.69,100,,,fee schedule,100% of APC rate,2577.69,100,,,fee schedule,100% of APC rate,130.98,145,,,fee schedule,145% of CMS fee schedule,2577.69,100,,,fee schedule,100% of APC rate,2577.69,100,,,fee schedule,100% of APC rate,2577.69,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2000,40,,1600,percent of total billed charges,40% of total billed charges,130.98,4000,
NEO TEE T-PIECE RESU,5801832,CDM,272,RC,,,Outpatient,,,97,77.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.6,80,,62.08,percent of total billed charges,80% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% of total billed charges,36.15,37.27,,28.92,percent of total billed charges,37.27% 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,38.8,40,,31.04,percent of total billed charges,40% of total billed charges,36.15,77.6,
STALEVO 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,31.25,25.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25,80,,20,percent of total billed charges,80% of total billed charges,11.65,37.27,,9.32,percent of total billed charges,37.27% of total billed charges,11.65,37.27,,9.32,percent of total billed charges,37.27% of total billed charges,11.65,37.27,,9.32,percent of total billed charges,37.27% 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,12.5,40,,10,percent of total billed charges,40% of total billed charges,11.65,25,
DILAUDID 1MG/ML INJ,6065130,CDM,636,RC,J1171,HCPCS,Outpatient,,,17.65,14.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.12,80,,11.3,percent of total billed charges,80% of total billed charges,6.58,37.27,,5.26,percent of total billed charges,37.27% of total billed charges,6.58,37.27,,5.26,percent of total billed charges,37.27% of total billed charges,6.58,37.27,,5.26,percent of total billed charges,37.27% 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,7.06,40,,5.65,percent of total billed charges,40% of total billed charges,6.58,14.12,
BETACAINE OINTMENT,6065130,CDM,636,RC,,,Outpatient,,,0.01,0.01,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,80,,0.01,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,0.01,0.01,
MORPHINE ORAL 20MG/5,5880901,CDM,637,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
CERON DM,6400014,CDM,250,RC,,,Outpatient,,,22.8,18.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.24,80,,14.59,percent of total billed charges,80% of total billed charges,8.5,37.27,,6.8,percent of total billed charges,37.27% of total billed charges,8.5,37.27,,6.8,percent of total billed charges,37.27% of total billed charges,8.5,37.27,,6.8,percent of total billed charges,37.27% 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,9.12,40,,7.3,percent of total billed charges,40% of total billed charges,8.5,18.24,
DESIPRAMINE 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,4.1,3.28,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.28,80,,2.62,percent of total billed charges,80% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% of total billed charges,1.53,37.27,,1.22,percent of total billed charges,37.27% 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,1.64,40,,1.31,percent of total billed charges,40% of total billed charges,1.53,3.28,
CLOTRIMAZOLE VAG CR,5880901,CDM,637,RC,,,Outpatient,,,27.3,21.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.84,80,,17.47,percent of total billed charges,80% of total billed charges,10.17,37.27,,8.14,percent of total billed charges,37.27% of total billed charges,10.17,37.27,,8.14,percent of total billed charges,37.27% of total billed charges,10.17,37.27,,8.14,percent of total billed charges,37.27% 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,10.92,40,,8.74,percent of total billed charges,40% of total billed charges,10.17,21.84,
PROTEIN S ANTIGEN,7000029,CDM,301,RC,,,Outpatient,,,462,369.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,369.6,80,,295.68,percent of total billed charges,80% of total billed charges,172.19,37.27,,137.75,percent of total billed charges,37.27% of total billed charges,172.19,37.27,,137.75,percent of total billed charges,37.27% of total billed charges,172.19,37.27,,137.75,percent of total billed charges,37.27% 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,184.8,40,,147.84,percent of total billed charges,40% of total billed charges,172.19,369.6,
ENSURE ENLIVE BOX,6400014,CDM,250,RC,,,Outpatient,,,5.65,4.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.52,80,,3.62,percent of total billed charges,80% of total billed charges,2.11,37.27,,1.69,percent of total billed charges,37.27% of total billed charges,2.11,37.27,,1.69,percent of total billed charges,37.27% of total billed charges,2.11,37.27,,1.69,percent of total billed charges,37.27% 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,2.26,40,,1.81,percent of total billed charges,40% of total billed charges,2.11,4.52,
BUFFERED SALT TAB,5880901,CDM,637,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
BISMATROL SUSP 5ML,5880901,CDM,637,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
FLUZONE 0.5M <64,6065130,CDM,636,RC,Q2038,HCPCS,Outpatient,,,225.45,180.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180.36,80,,144.29,percent of total billed charges,80% of total billed charges,84.03,37.27,,67.22,percent of total billed charges,37.27% of total billed charges,84.03,37.27,,67.22,percent of total billed charges,37.27% of total billed charges,84.03,37.27,,67.22,percent of total billed charges,37.27% 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,90.18,40,,72.14,percent of total billed charges,40% of total billed charges,84.03,180.36,
FLUZONE PED DOSE,6065130,CDM,636,RC,Q2038,HCPCS,Outpatient,,,59.05,47.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.24,80,,37.79,percent of total billed charges,80% of total billed charges,22.01,37.27,,17.61,percent of total billed charges,37.27% of total billed charges,22.01,37.27,,17.61,percent of total billed charges,37.27% of total billed charges,22.01,37.27,,17.61,percent of total billed charges,37.27% 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,23.62,40,,18.9,percent of total billed charges,40% of total billed charges,22.01,47.24,
SURG PATH LEVEL II,7012032,CDM,300,RC,88302,HCPCS,Outpatient,,,164,131.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.2,80,,104.96,percent of total billed charges,80% of total billed charges,61.12,37.27,,48.9,percent of total billed charges,37.27% of total billed charges,61.12,37.27,,48.9,percent of total billed charges,37.27% of total billed charges,61.12,37.27,,48.9,percent of total billed charges,37.27% of total billed charges,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,33.94,145,,,fee schedule,145% of CMS fee schedule,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,40,,52.48,percent of total billed charges,40% of total billed charges,24.55,131.2,
FENOFIBRATE 160MG,5880901,CDM,637,RC,,,Outpatient,,,8.1,6.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.48,80,,5.18,percent of total billed charges,80% of total billed charges,3.02,37.27,,2.42,percent of total billed charges,37.27% of total billed charges,3.02,37.27,,2.42,percent of total billed charges,37.27% of total billed charges,3.02,37.27,,2.42,percent of total billed charges,37.27% 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,3.24,40,,2.59,percent of total billed charges,40% of total billed charges,3.02,6.48,
ZONISAMIDE 100MG CAP,6400014,CDM,250,RC,A9270,HCPCS,Outpatient,,,7.45,5.96,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.96,80,,4.77,percent of total billed charges,80% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% of total billed charges,2.78,37.27,,2.22,percent of total billed charges,37.27% 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,2.98,40,,2.38,percent of total billed charges,40% of total billed charges,2.78,5.96,
LUMIGAN 0.01% OPTH,5880901,CDM,637,RC,,,Outpatient,,,877.85,702.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,702.28,80,,561.82,percent of total billed charges,80% of total billed charges,327.17,37.27,,261.74,percent of total billed charges,37.27% of total billed charges,327.17,37.27,,261.74,percent of total billed charges,37.27% of total billed charges,327.17,37.27,,261.74,percent of total billed charges,37.27% 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,351.14,40,,280.91,percent of total billed charges,40% of total billed charges,327.17,702.28,
FLOVENT HFA 44MCG/AC,5880901,CDM,637,RC,,,Outpatient,,,711.75,569.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,569.4,80,,455.52,percent of total billed charges,80% of total billed charges,265.27,37.27,,212.22,percent of total billed charges,37.27% of total billed charges,265.27,37.27,,212.22,percent of total billed charges,37.27% of total billed charges,265.27,37.27,,212.22,percent of total billed charges,37.27% 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,284.7,40,,227.76,percent of total billed charges,40% of total billed charges,265.27,569.4,
FLOW CYTOMETRY TC,7012032,CDM,300,RC,88184,HCPCS,Outpatient,,,221,176.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,176.8,80,,141.44,percent of total billed charges,80% of total billed charges,82.37,37.27,,65.9,percent of total billed charges,37.27% of total billed charges,82.37,37.27,,65.9,percent of total billed charges,37.27% of total billed charges,82.37,37.27,,65.9,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,99.19,145,,,fee schedule,145% of CMS fee schedule,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.4,40,,70.72,percent of total billed charges,40% of total billed charges,82.37,296.36,
HYDROXYZINE 100MG IJ,6065130,CDM,636,RC,J3410,HCPCS,Outpatient,,,7.03,5.62,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.62,80,,4.5,percent of total billed charges,80% of total billed charges,2.62,37.27,,2.1,percent of total billed charges,37.27% of total billed charges,2.62,37.27,,2.1,percent of total billed charges,37.27% of total billed charges,2.62,37.27,,2.1,percent of total billed charges,37.27% 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,2.81,40,,2.25,percent of total billed charges,40% of total billed charges,2.62,5.62,
FOLIC ACID 800MCG,6065130,CDM,636,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
VENIPORT LAB,5801832,CDM,272,RC,36591,HCPCS,Outpatient,,,385,308.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308,80,,246.4,percent of total billed charges,80% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,35.22,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154,40,,123.2,percent of total billed charges,40% of total billed charges,35.22,308,
CAPTOPRIL 50MG TAB,5880901,CDM,637,RC,,,Outpatient,,,9.85,7.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.88,80,,6.3,percent of total billed charges,80% of total billed charges,3.67,37.27,,2.94,percent of total billed charges,37.27% of total billed charges,3.67,37.27,,2.94,percent of total billed charges,37.27% of total billed charges,3.67,37.27,,2.94,percent of total billed charges,37.27% 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,3.94,40,,3.15,percent of total billed charges,40% of total billed charges,3.67,7.88,
HELIOX THERAPY,7412476,CDM,271,RC,,,Outpatient,,,8,6.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.4,80,,5.12,percent of total billed charges,80% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% of total billed charges,2.98,37.27,,2.38,percent of total billed charges,37.27% 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,3.2,40,,2.56,percent of total billed charges,40% of total billed charges,2.98,6.4,
ONGLYZA 2.5MG TAB,6065130,CDM,636,RC,A9270,HCPCS,Outpatient,,,66.15,52.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.92,80,,42.34,percent of total billed charges,80% of total billed charges,24.65,37.27,,19.72,percent of total billed charges,37.27% of total billed charges,24.65,37.27,,19.72,percent of total billed charges,37.27% of total billed charges,24.65,37.27,,19.72,percent of total billed charges,37.27% 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,26.46,40,,21.17,percent of total billed charges,40% of total billed charges,24.65,52.92,
EPLERENONE 50MG TAB,5880901,CDM,637,RC,,,Outpatient,,,14.75,11.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.8,80,,9.44,percent of total billed charges,80% of total billed charges,5.5,37.27,,4.4,percent of total billed charges,37.27% of total billed charges,5.5,37.27,,4.4,percent of total billed charges,37.27% of total billed charges,5.5,37.27,,4.4,percent of total billed charges,37.27% 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,5.9,40,,4.72,percent of total billed charges,40% of total billed charges,5.5,11.8,
SYMBICORT INH 80/4.5,6400014,CDM,250,RC,,,Outpatient,,,1069.9,855.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,855.92,80,,684.74,percent of total billed charges,80% of total billed charges,398.75,37.27,,319,percent of total billed charges,37.27% of total billed charges,398.75,37.27,,319,percent of total billed charges,37.27% of total billed charges,398.75,37.27,,319,percent of total billed charges,37.27% 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,427.96,40,,342.37,percent of total billed charges,40% of total billed charges,398.75,855.92,
POWDER STIMULEN 1 GR,5801832,CDM,272,RC,,,Outpatient,,,87,69.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% 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,34.8,40,,27.84,percent of total billed charges,40% of total billed charges,32.42,69.6,
PHENOBARBITAL 5ML,5880901,CDM,637,RC,,,Outpatient,,,7.8,6.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.24,80,,4.99,percent of total billed charges,80% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% of total billed charges,2.91,37.27,,2.33,percent of total billed charges,37.27% 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,3.12,40,,2.5,percent of total billed charges,40% of total billed charges,2.91,6.24,
TAMIFLU 45MG CAP,6400014,CDM,250,RC,,,Outpatient,,,57,45.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% 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,22.8,40,,18.24,percent of total billed charges,40% of total billed charges,21.24,45.6,
XARELTO 15MG TAB,6400014,CDM,250,RC,A9270,HCPCS,Outpatient,,,77.65,62.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.12,80,,49.7,percent of total billed charges,80% of total billed charges,28.94,37.27,,23.15,percent of total billed charges,37.27% of total billed charges,28.94,37.27,,23.15,percent of total billed charges,37.27% of total billed charges,28.94,37.27,,23.15,percent of total billed charges,37.27% 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,31.06,40,,24.85,percent of total billed charges,40% of total billed charges,28.94,62.12,
VAGISTAT-3 SUPP/CRM,6400014,CDM,250,RC,,,Outpatient,,,40.4,32.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,80,,25.86,percent of total billed charges,80% of total billed charges,15.06,37.27,,12.05,percent of total billed charges,37.27% of total billed charges,15.06,37.27,,12.05,percent of total billed charges,37.27% of total billed charges,15.06,37.27,,12.05,percent of total billed charges,37.27% 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,16.16,40,,12.93,percent of total billed charges,40% of total billed charges,15.06,32.32,
PARACENTESIS,6000160,CDM,361,RC,49082,HCPCS,Outpatient,,,1038,830.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,830.4,80,,664.32,percent of total billed charges,80% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,747.4,100,,,fee schedule,100% of APC rate,747.4,100,,,fee schedule,100% of APC rate,747.4,100,,,fee schedule,100% of APC rate,102.05,145,,,fee schedule,145% of CMS fee schedule,747.4,100,,,fee schedule,100% of APC rate,747.4,100,,,fee schedule,100% of APC rate,747.4,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,415.2,40,,332.16,percent of total billed charges,40% of total billed charges,102.05,830.4,
DILTIAZEM 90MG TAB,5880901,CDM,637,RC,,,Outpatient,,,2.95,2.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,80,,1.89,percent of total billed charges,80% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% 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,1.18,40,,0.94,percent of total billed charges,40% of total billed charges,1.1,2.36,
BLOW FISH,7412476,CDM,271,RC,,,Outpatient,,,22,17.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.6,80,,14.08,percent of total billed charges,80% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% of total billed charges,8.2,37.27,,6.56,percent of total billed charges,37.27% 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,8.8,40,,7.04,percent of total billed charges,40% of total billed charges,8.2,17.6,
SILVER CEL NON AD 4X,5801832,CDM,272,RC,,,Outpatient,,,92,73.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% 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,36.8,40,,29.44,percent of total billed charges,40% of total billed charges,34.29,73.6,
HYDROXYZINE 25MG INJ,6065130,CDM,636,RC,J3410,HCPCS,Outpatient,,,12.8,10.24,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.24,80,,8.19,percent of total billed charges,80% of total billed charges,4.77,37.27,,3.82,percent of total billed charges,37.27% of total billed charges,4.77,37.27,,3.82,percent of total billed charges,37.27% of total billed charges,4.77,37.27,,3.82,percent of total billed charges,37.27% 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,5.12,40,,4.1,percent of total billed charges,40% of total billed charges,4.77,10.24,
DOBUTAMINE 250MG PM,6065130,CDM,636,RC,J1250,HCPCS,Outpatient,,,147.4,117.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.92,80,,94.34,percent of total billed charges,80% of total billed charges,54.94,37.27,,43.95,percent of total billed charges,37.27% of total billed charges,54.94,37.27,,43.95,percent of total billed charges,37.27% of total billed charges,54.94,37.27,,43.95,percent of total billed charges,37.27% 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,58.96,40,,47.17,percent of total billed charges,40% of total billed charges,54.94,117.92,
PARACENTESIS-ENDO,8602000,CDM,750,RC,SURG,HCPCS,Outpatient,,,1038,830.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,830.4,80,,664.32,percent of total billed charges,80% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% of total billed charges,386.86,37.27,,309.49,percent of total billed charges,37.27% 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,415.2,40,,332.16,percent of total billed charges,40% of total billed charges,386.86,830.4,
MAG AL + SIMETH UD,5880901,CDM,637,RC,,,Outpatient,,,12.9,10.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.32,80,,8.26,percent of total billed charges,80% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% 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,5.16,40,,4.13,percent of total billed charges,40% of total billed charges,4.81,10.32,
ENSURE B.PECAN 237ML,5880901,CDM,637,RC,,,Outpatient,,,6.6,5.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.28,80,,4.22,percent of total billed charges,80% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% of total billed charges,2.46,37.27,,1.97,percent of total billed charges,37.27% 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,2.64,40,,2.11,percent of total billed charges,40% of total billed charges,2.46,5.28,
ERGOCACIFEROL 1.25MG,6400014,CDM,250,RC,,,Outpatient,,,10.55,8.44,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.44,80,,6.75,percent of total billed charges,80% of total billed charges,3.93,37.27,,3.14,percent of total billed charges,37.27% of total billed charges,3.93,37.27,,3.14,percent of total billed charges,37.27% of total billed charges,3.93,37.27,,3.14,percent of total billed charges,37.27% 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,4.22,40,,3.38,percent of total billed charges,40% of total billed charges,3.93,8.44,
SODIUM CL 3% NEB TXT,6065130,CDM,636,RC,,,Outpatient,,,4.75,3.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.8,80,,3.04,percent of total billed charges,80% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% of total billed charges,1.77,37.27,,1.42,percent of total billed charges,37.27% 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,1.9,40,,1.52,percent of total billed charges,40% of total billed charges,1.77,3.8,
LUPRON DEPOT 45MG,6065130,CDM,636,RC,J9217,HCPCS,Outpatient,,,29575.55,23660.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23660.44,80,,18928.35,percent of total billed charges,80% of total billed charges,11022.81,37.27,,8818.25,percent of total billed charges,37.27% of total billed charges,11022.81,37.27,,8818.25,percent of total billed charges,37.27% of total billed charges,11022.81,37.27,,8818.25,percent of total billed charges,37.27% of total billed charges,176.51,100,,,fee schedule,100% of APC rate,176.51,100,,,fee schedule,100% of APC rate,176.51,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,176.51,100,,,fee schedule,100% of APC rate,176.51,100,,,fee schedule,100% of APC rate,176.51,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11830.22,40,,9464.18,percent of total billed charges,40% of total billed charges,176.51,23660.44,
SHRT THROW STIFF SNA,5801832,CDM,272,RC,,,Outpatient,,,173,138.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% 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,69.2,40,,55.36,percent of total billed charges,40% of total billed charges,64.48,138.4,
GRALISE 600MG,6400014,CDM,250,RC,A9270,HCPCS,Outpatient,,,17.95,14.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.36,80,,11.49,percent of total billed charges,80% of total billed charges,6.69,37.27,,5.35,percent of total billed charges,37.27% of total billed charges,6.69,37.27,,5.35,percent of total billed charges,37.27% of total billed charges,6.69,37.27,,5.35,percent of total billed charges,37.27% 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,7.18,40,,5.74,percent of total billed charges,40% of total billed charges,6.69,14.36,
IBANDRONATE 150MG,5880901,CDM,637,RC,,,Outpatient,,,664.45,531.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,531.56,80,,425.25,percent of total billed charges,80% of total billed charges,247.64,37.27,,198.11,percent of total billed charges,37.27% of total billed charges,247.64,37.27,,198.11,percent of total billed charges,37.27% of total billed charges,247.64,37.27,,198.11,percent of total billed charges,37.27% 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,265.78,40,,212.62,percent of total billed charges,40% of total billed charges,247.64,531.56,
LINZESS 145MG TAB,6400014,CDM,250,RC,A9270,HCPCS,Outpatient,,,73.75,59.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59,80,,47.2,percent of total billed charges,80% of total billed charges,27.49,37.27,,21.99,percent of total billed charges,37.27% of total billed charges,27.49,37.27,,21.99,percent of total billed charges,37.27% of total billed charges,27.49,37.27,,21.99,percent of total billed charges,37.27% 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,29.5,40,,23.6,percent of total billed charges,40% of total billed charges,27.49,59,
LARYNGEAL MASK AIRWA,5801832,CDM,272,RC,,,Outpatient,,,96,76.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% 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,38.4,40,,30.72,percent of total billed charges,40% of total billed charges,35.78,76.8,
INTRODUCER BOUGIE,5801832,CDM,272,RC,,,Outpatient,,,34,27.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.2,80,,21.76,percent of total billed charges,80% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% of total billed charges,12.67,37.27,,10.14,percent of total billed charges,37.27% 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,13.6,40,,10.88,percent of total billed charges,40% of total billed charges,12.67,27.2,
PEG PLACEMENT W GUID,8602000,CDM,750,RC,SURG,HCPCS,Outpatient,,,3140,2512.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2512,80,,2009.6,percent of total billed charges,80% of total billed charges,1170.28,37.27,,936.22,percent of total billed charges,37.27% of total billed charges,1170.28,37.27,,936.22,percent of total billed charges,37.27% of total billed charges,1170.28,37.27,,936.22,percent of total billed charges,37.27% 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,1256,40,,1004.8,percent of total billed charges,40% of total billed charges,1170.28,2512,
PEG TUBE CHNG NO GUI,8602000,CDM,750,RC,SURG,HCPCS,Outpatient,,,474,379.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,379.2,80,,303.36,percent of total billed charges,80% of total billed charges,176.66,37.27,,141.33,percent of total billed charges,37.27% of total billed charges,176.66,37.27,,141.33,percent of total billed charges,37.27% of total billed charges,176.66,37.27,,141.33,percent of total billed charges,37.27% 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,189.6,40,,151.68,percent of total billed charges,40% of total billed charges,176.66,379.2,
OB PROCEDURE LEVEL 1,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,554,443.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% 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,221.6,40,,177.28,percent of total billed charges,40% of total billed charges,206.48,443.2,
PROMETHAZINE DM (OZ),6400014,CDM,250,RC,,,Outpatient,,,9.45,7.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.56,80,,6.05,percent of total billed charges,80% of total billed charges,3.52,37.27,,2.82,percent of total billed charges,37.27% of total billed charges,3.52,37.27,,2.82,percent of total billed charges,37.27% of total billed charges,3.52,37.27,,2.82,percent of total billed charges,37.27% 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,3.78,40,,3.02,percent of total billed charges,40% of total billed charges,3.52,7.56,
IV INFUSION SEQ 1 HR,5811182,CDM,260,RC,96367,HCPCS,Outpatient,,,134,107.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,37.19,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,40,,42.88,percent of total billed charges,40% of total billed charges,37.19,107.2,
IV INFUSION CONCUR,5811182,CDM,260,RC,96368,HCPCS,Outpatient,,,146,116.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.09,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,26.09,116.8,
LACTAID FAST ACTING,5880901,CDM,637,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CLINIMIX 4.25/5% 1L,6400014,CDM,250,RC,,,Outpatient,,,169.3,135.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.44,80,,108.35,percent of total billed charges,80% of total billed charges,63.1,37.27,,50.48,percent of total billed charges,37.27% of total billed charges,63.1,37.27,,50.48,percent of total billed charges,37.27% of total billed charges,63.1,37.27,,50.48,percent of total billed charges,37.27% 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,67.72,40,,54.18,percent of total billed charges,40% of total billed charges,63.1,135.44,
QUININE 324MG TABLET,6400014,CDM,250,RC,,,Outpatient,,,26.75,21.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.4,80,,17.12,percent of total billed charges,80% of total billed charges,9.97,37.27,,7.98,percent of total billed charges,37.27% of total billed charges,9.97,37.27,,7.98,percent of total billed charges,37.27% of total billed charges,9.97,37.27,,7.98,percent of total billed charges,37.27% 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,10.7,40,,8.56,percent of total billed charges,40% of total billed charges,9.97,21.4,
CENTRAL LINE INSERT,5612346,CDM,761,RC,SURG,HCPCS,Outpatient,,,2946,2356.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2356.8,80,,1885.44,percent of total billed charges,80% of total billed charges,1097.97,37.27,,878.38,percent of total billed charges,37.27% of total billed charges,1097.97,37.27,,878.38,percent of total billed charges,37.27% of total billed charges,1097.97,37.27,,878.38,percent of total billed charges,37.27% 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,1178.4,40,,942.72,percent of total billed charges,40% of total billed charges,1097.97,2356.8,
IMMUNE GLOBULIN 10GM,6065130,CDM,636,RC,J1459,HCPCS,Outpatient,,,134.2,107.36,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.36,80,,85.89,percent of total billed charges,80% of total billed charges,50.02,37.27,,40.02,percent of total billed charges,37.27% of total billed charges,50.02,37.27,,40.02,percent of total billed charges,37.27% of total billed charges,50.02,37.27,,40.02,percent of total billed charges,37.27% of total billed charges,48.58,100,,,fee schedule,100% of APC rate,48.58,100,,,fee schedule,100% of APC rate,48.58,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,48.58,100,,,fee schedule,100% of APC rate,48.58,100,,,fee schedule,100% of APC rate,48.58,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.68,40,,42.94,percent of total billed charges,40% of total billed charges,48.58,107.36,
VAGIFEM 10MCG VAG TB,6400014,CDM,250,RC,,,Outpatient,,,242.35,193.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.88,80,,155.1,percent of total billed charges,80% of total billed charges,90.32,37.27,,72.26,percent of total billed charges,37.27% of total billed charges,90.32,37.27,,72.26,percent of total billed charges,37.27% of total billed charges,90.32,37.27,,72.26,percent of total billed charges,37.27% 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,96.94,40,,77.55,percent of total billed charges,40% of total billed charges,90.32,193.88,
CENTRAL LINE INSERT,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,2946,2356.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2356.8,80,,1885.44,percent of total billed charges,80% of total billed charges,1097.97,37.27,,878.38,percent of total billed charges,37.27% of total billed charges,1097.97,37.27,,878.38,percent of total billed charges,37.27% of total billed charges,1097.97,37.27,,878.38,percent of total billed charges,37.27% 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,1178.4,40,,942.72,percent of total billed charges,40% of total billed charges,1097.97,2356.8,
IEP W/INTERPRETATION,7012032,CDM,300,RC,,,Outpatient,,,348,278.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% 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,139.2,40,,111.36,percent of total billed charges,40% of total billed charges,129.7,278.4,
TRAY UVC GEN PROC,5801832,CDM,272,RC,,,Outpatient,,,224,179.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.2,80,,143.36,percent of total billed charges,80% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% 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,89.6,40,,71.68,percent of total billed charges,40% of total billed charges,83.48,179.2,
TRAY CHEST THOR 9.6F,5801832,CDM,272,RC,,,Outpatient,,,82,65.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.6,80,,52.48,percent of total billed charges,80% of total billed charges,30.56,37.27,,24.45,percent of total billed charges,37.27% of total billed charges,30.56,37.27,,24.45,percent of total billed charges,37.27% of total billed charges,30.56,37.27,,24.45,percent of total billed charges,37.27% 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,32.8,40,,26.24,percent of total billed charges,40% of total billed charges,30.56,65.6,
TRAY LUMB MYEL 25X1,5801832,CDM,272,RC,,,Outpatient,,,64,51.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% 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,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,23.85,51.2,
PREPNEUMOCOCCAL AB,7012032,CDM,300,RC,,,Outpatient,,,1642.2,1313.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1313.76,80,,1051.01,percent of total billed charges,80% of total billed charges,612.05,37.27,,489.64,percent of total billed charges,37.27% of total billed charges,612.05,37.27,,489.64,percent of total billed charges,37.27% of total billed charges,612.05,37.27,,489.64,percent of total billed charges,37.27% 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,656.88,40,,525.5,percent of total billed charges,40% of total billed charges,612.05,1313.76,
LMA UNIQUE SZ 1,5801832,CDM,272,RC,,,Outpatient,,,289,231.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,107.71,37.27,,86.17,percent of total billed charges,37.27% of total billed charges,107.71,37.27,,86.17,percent of total billed charges,37.27% of total billed charges,107.71,37.27,,86.17,percent of total billed charges,37.27% 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,115.6,40,,92.48,percent of total billed charges,40% of total billed charges,107.71,231.2,
PREVNAR 13,6065130,CDM,636,RC,90670,HCPCS,Outpatient,,,1634.8,1307.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1307.84,80,,1046.27,percent of total billed charges,80% of total billed charges,609.29,37.27,,487.43,percent of total billed charges,37.27% of total billed charges,609.29,37.27,,487.43,percent of total billed charges,37.27% of total billed charges,609.29,37.27,,487.43,percent of total billed charges,37.27% 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,653.92,40,,523.14,percent of total billed charges,40% of total billed charges,609.29,1307.84,
FREE THYROXINE INDEX,7012032,CDM,300,RC,,,Outpatient,,,80,64.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,80,,51.2,percent of total billed charges,80% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% of total billed charges,29.82,37.27,,23.86,percent of total billed charges,37.27% 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,32,40,,25.6,percent of total billed charges,40% of total billed charges,29.82,64,
ORPHENADRINE 60MG/2M,6065130,CDM,636,RC,J2360,HCPCS,Outpatient,,,24.55,19.64,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.64,80,,15.71,percent of total billed charges,80% of total billed charges,9.15,37.27,,7.32,percent of total billed charges,37.27% of total billed charges,9.15,37.27,,7.32,percent of total billed charges,37.27% of total billed charges,9.15,37.27,,7.32,percent of total billed charges,37.27% 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,9.82,40,,7.86,percent of total billed charges,40% of total billed charges,9.15,19.64,
TAPENTADOL LEVEL,7000029,CDM,301,RC,80372,HCPCS,Outpatient,,,283,226.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,226.4,80,,181.12,percent of total billed charges,80% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% of total billed charges,105.47,37.27,,84.38,percent of total billed charges,37.27% 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,113.2,40,,90.56,percent of total billed charges,40% of total billed charges,105.47,226.4,
BYSTOLIC 2.5MG TAB,5880901,CDM,637,RC,,,Outpatient,,,24.9,19.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.92,80,,15.94,percent of total billed charges,80% of total billed charges,9.28,37.27,,7.42,percent of total billed charges,37.27% of total billed charges,9.28,37.27,,7.42,percent of total billed charges,37.27% of total billed charges,9.28,37.27,,7.42,percent of total billed charges,37.27% 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,9.96,40,,7.97,percent of total billed charges,40% of total billed charges,9.28,19.92,
CHEM 20,7012032,CDM,300,RC,,,Outpatient,,,322,257.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,257.6,80,,206.08,percent of total billed charges,80% of total billed charges,120.01,37.27,,96.01,percent of total billed charges,37.27% of total billed charges,120.01,37.27,,96.01,percent of total billed charges,37.27% of total billed charges,120.01,37.27,,96.01,percent of total billed charges,37.27% 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,128.8,40,,103.04,percent of total billed charges,40% of total billed charges,120.01,257.6,
CELIAC DIS COMP MAYO,7012032,CDM,300,RC,,,Outpatient,,,189,151.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.2,80,,120.96,percent of total billed charges,80% of total billed charges,70.44,37.27,,56.35,percent of total billed charges,37.27% of total billed charges,70.44,37.27,,56.35,percent of total billed charges,37.27% of total billed charges,70.44,37.27,,56.35,percent of total billed charges,37.27% 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,75.6,40,,60.48,percent of total billed charges,40% of total billed charges,70.44,151.2,
IMMOBILIZER-SHOULDER,5645742,CDM,270,RC,,,Outpatient,,,37,29.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.6,80,,23.68,percent of total billed charges,80% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% of total billed charges,13.79,37.27,,11.03,percent of total billed charges,37.27% 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,14.8,40,,11.84,percent of total billed charges,40% of total billed charges,13.79,29.6,
VITAMIN D3 1000 UN,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
GABAPENTIN 250MG/5ML,5880901,CDM,637,RC,,,Outpatient,,,32.4,25.92,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.92,80,,20.74,percent of total billed charges,80% of total billed charges,12.08,37.27,,9.66,percent of total billed charges,37.27% of total billed charges,12.08,37.27,,9.66,percent of total billed charges,37.27% of total billed charges,12.08,37.27,,9.66,percent of total billed charges,37.27% 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,12.96,40,,10.37,percent of total billed charges,40% of total billed charges,12.08,25.92,
LIPITOR 10MG TAB,5880901,CDM,637,RC,,,Outpatient,,,13.1,10.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.48,80,,8.38,percent of total billed charges,80% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% 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,5.24,40,,4.19,percent of total billed charges,40% of total billed charges,4.88,10.48,
TRAY LACERATION,5801832,CDM,272,RC,,,Outpatient,,,45.6,36.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.48,80,,29.18,percent of total billed charges,80% of total billed charges,17,37.27,,13.6,percent of total billed charges,37.27% of total billed charges,17,37.27,,13.6,percent of total billed charges,37.27% of total billed charges,17,37.27,,13.6,percent of total billed charges,37.27% 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,18.24,40,,14.59,percent of total billed charges,40% of total billed charges,17,36.48,
BETAMETHASONE 6MGINJ,6065130,CDM,636,RC,J0702,HCPCS,Outpatient,,,45,36.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% 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,18,40,,14.4,percent of total billed charges,40% of total billed charges,16.77,36,
MONSEL'S SOLN 8ML,5880901,CDM,637,RC,,,Outpatient,,,49.7,39.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.76,80,,31.81,percent of total billed charges,80% of total billed charges,18.52,37.27,,14.82,percent of total billed charges,37.27% of total billed charges,18.52,37.27,,14.82,percent of total billed charges,37.27% of total billed charges,18.52,37.27,,14.82,percent of total billed charges,37.27% 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,19.88,40,,15.9,percent of total billed charges,40% of total billed charges,18.52,39.76,
ZOLEDR ACID5MGPER1MG,6065130,CDM,636,RC,J3489,HCPCS,Outpatient,,,450.3,360.24,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360.24,80,,288.19,percent of total billed charges,80% of total billed charges,167.83,37.27,,134.26,percent of total billed charges,37.27% of total billed charges,167.83,37.27,,134.26,percent of total billed charges,37.27% of total billed charges,167.83,37.27,,134.26,percent of total billed charges,37.27% 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,180.12,40,,144.1,percent of total billed charges,40% of total billed charges,167.83,360.24,
HYDROC/APAP 7.5/325,5880901,CDM,637,RC,,,Outpatient,,,3.1,2.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.48,80,,1.98,percent of total billed charges,80% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% of total billed charges,1.16,37.27,,0.93,percent of total billed charges,37.27% 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,1.24,40,,0.99,percent of total billed charges,40% of total billed charges,1.16,2.48,
CYCLOSPORA,7012032,CDM,300,RC,,,Outpatient,,,67,53.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.6,80,,42.88,percent of total billed charges,80% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% of total billed charges,24.97,37.27,,19.98,percent of total billed charges,37.27% 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,26.8,40,,21.44,percent of total billed charges,40% of total billed charges,24.97,53.6,
BLADE CERVICAL BIOPS,5801832,CDM,272,RC,,,Outpatient,,,46.75,37.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.4,80,,29.92,percent of total billed charges,80% of total billed charges,17.42,37.27,,13.94,percent of total billed charges,37.27% of total billed charges,17.42,37.27,,13.94,percent of total billed charges,37.27% of total billed charges,17.42,37.27,,13.94,percent of total billed charges,37.27% 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,18.7,40,,14.96,percent of total billed charges,40% of total billed charges,17.42,37.4,
HEMOCYTE PLUS CAP,6400014,CDM,250,RC,,,Outpatient,,,2.4,1.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.92,80,,1.54,percent of total billed charges,80% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% of total billed charges,0.89,37.27,,0.71,percent of total billed charges,37.27% 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,0.96,40,,0.77,percent of total billed charges,40% of total billed charges,0.89,1.92,
PCA MORPH 2MG/ML BAG,6400014,CDM,250,RC,,,Outpatient,,,285.15,228.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.12,80,,182.5,percent of total billed charges,80% of total billed charges,106.28,37.27,,85.02,percent of total billed charges,37.27% of total billed charges,106.28,37.27,,85.02,percent of total billed charges,37.27% of total billed charges,106.28,37.27,,85.02,percent of total billed charges,37.27% 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,114.06,40,,91.25,percent of total billed charges,40% of total billed charges,106.28,228.12,
FLULAVAL 0.5ML INJ,6065130,CDM,636,RC,90658,HCPCS,Outpatient,,,60.3,48.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.24,80,,38.59,percent of total billed charges,80% of total billed charges,22.47,37.27,,17.98,percent of total billed charges,37.27% of total billed charges,22.47,37.27,,17.98,percent of total billed charges,37.27% of total billed charges,22.47,37.27,,17.98,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.86,100,,,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,24.12,40,,19.3,percent of total billed charges,40% of total billed charges,21.86,48.24,
LATUDA 20MG TAB,5880901,CDM,637,RC,,,Outpatient,,,164.55,131.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.64,80,,105.31,percent of total billed charges,80% of total billed charges,61.33,37.27,,49.06,percent of total billed charges,37.27% of total billed charges,61.33,37.27,,49.06,percent of total billed charges,37.27% of total billed charges,61.33,37.27,,49.06,percent of total billed charges,37.27% 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,65.82,40,,52.66,percent of total billed charges,40% of total billed charges,61.33,131.64,
VAGISIL CREAM,6400014,CDM,250,RC,,,Outpatient,,,11.6,9.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.28,80,,7.42,percent of total billed charges,80% of total billed charges,4.32,37.27,,3.46,percent of total billed charges,37.27% of total billed charges,4.32,37.27,,3.46,percent of total billed charges,37.27% of total billed charges,4.32,37.27,,3.46,percent of total billed charges,37.27% 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,4.64,40,,3.71,percent of total billed charges,40% of total billed charges,4.32,9.28,
CO ENZYME Q 100MG,5880901,CDM,637,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
MAG SULFATE 1GM VL,6065130,CDM,636,RC,J3475,HCPCS,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
MMR IMMUNITY TITER,7012032,CDM,300,RC,,,Outpatient,,,413,330.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% 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,165.2,40,,132.16,percent of total billed charges,40% of total billed charges,153.93,330.4,
ADH-ADP,7012032,CDM,300,RC,,,Outpatient,,,39,31.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.2,80,,24.96,percent of total billed charges,80% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% of total billed charges,14.54,37.27,,11.63,percent of total billed charges,37.27% 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,15.6,40,,12.48,percent of total billed charges,40% of total billed charges,14.54,31.2,
VITAMIN D3 50000UN,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
OXYCODONE/ACET10/325,6400014,CDM,250,RC,,,Outpatient,,,12.55,10.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.04,80,,8.03,percent of total billed charges,80% of total billed charges,4.68,37.27,,3.74,percent of total billed charges,37.27% of total billed charges,4.68,37.27,,3.74,percent of total billed charges,37.27% of total billed charges,4.68,37.27,,3.74,percent of total billed charges,37.27% 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,5.02,40,,4.02,percent of total billed charges,40% of total billed charges,4.68,10.04,
CO-ENZYME Q10 30MG,5880901,CDM,637,RC,,,Outpatient,,,6.3,5.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.04,80,,4.03,percent of total billed charges,80% of total billed charges,2.35,37.27,,1.88,percent of total billed charges,37.27% of total billed charges,2.35,37.27,,1.88,percent of total billed charges,37.27% of total billed charges,2.35,37.27,,1.88,percent of total billed charges,37.27% 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,2.52,40,,2.02,percent of total billed charges,40% of total billed charges,2.35,5.04,
FREE TESTO-SHBG PEDI,7039034,CDM,311,RC,,,Outpatient,,,688,550.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,550.4,80,,440.32,percent of total billed charges,80% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% 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,275.2,40,,220.16,percent of total billed charges,40% of total billed charges,256.42,550.4,
INFLIX CONC-ANTI-INF,7012032,CDM,300,RC,,,Outpatient,,,174,139.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,139.2,80,,111.36,percent of total billed charges,80% of total billed charges,64.85,37.27,,51.88,percent of total billed charges,37.27% of total billed charges,64.85,37.27,,51.88,percent of total billed charges,37.27% of total billed charges,64.85,37.27,,51.88,percent of total billed charges,37.27% 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,69.6,40,,55.68,percent of total billed charges,40% of total billed charges,64.85,139.2,
ELIQUIS 5MG TAB,5880901,CDM,637,RC,,,Outpatient,,,40.5,32.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,80,,25.92,percent of total billed charges,80% of total billed charges,15.09,37.27,,12.07,percent of total billed charges,37.27% of total billed charges,15.09,37.27,,12.07,percent of total billed charges,37.27% of total billed charges,15.09,37.27,,12.07,percent of total billed charges,37.27% 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,16.2,40,,12.96,percent of total billed charges,40% of total billed charges,15.09,32.4,
COUDE INSERT-COMPLEX,8830002,CDM,450,RC,51703,HCPCS,Outpatient,,,198,158.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,106.68,145,,,fee schedule,145% of CMS fee schedule,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,40,,63.36,percent of total billed charges,40% of total billed charges,73.79,158.4,
CLEARLINK BLOOD SET,5801832,CDM,272,RC,,,Outpatient,,,27.6,22.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.08,80,,17.66,percent of total billed charges,80% of total billed charges,10.29,37.27,,8.23,percent of total billed charges,37.27% of total billed charges,10.29,37.27,,8.23,percent of total billed charges,37.27% of total billed charges,10.29,37.27,,8.23,percent of total billed charges,37.27% 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,11.04,40,,8.83,percent of total billed charges,40% of total billed charges,10.29,22.08,
CLEARLK VENT NITRO,5801832,CDM,272,RC,,,Outpatient,,,26.6,21.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.28,80,,17.02,percent of total billed charges,80% of total billed charges,9.91,37.27,,7.93,percent of total billed charges,37.27% of total billed charges,9.91,37.27,,7.93,percent of total billed charges,37.27% of total billed charges,9.91,37.27,,7.93,percent of total billed charges,37.27% 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,10.64,40,,8.51,percent of total billed charges,40% of total billed charges,9.91,21.28,
ANCA PROFILE,7012032,CDM,300,RC,,,Outpatient,,,292.24,233.79,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,233.79,80,,187.03,percent of total billed charges,80% of total billed charges,108.92,37.27,,87.14,percent of total billed charges,37.27% of total billed charges,108.92,37.27,,87.14,percent of total billed charges,37.27% of total billed charges,108.92,37.27,,87.14,percent of total billed charges,37.27% 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,116.9,40,,93.52,percent of total billed charges,40% of total billed charges,108.92,233.79,
MUCUS SINUS RELIEF,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
BOOSTRIX (TDAP),6065130,CDM,636,RC,90715,HCPCS,Outpatient,,,192.4,153.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,153.92,80,,123.14,percent of total billed charges,80% of total billed charges,71.71,37.27,,57.37,percent of total billed charges,37.27% of total billed charges,71.71,37.27,,57.37,percent of total billed charges,37.27% of total billed charges,71.71,37.27,,57.37,percent of total billed charges,37.27% 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,76.96,40,,61.57,percent of total billed charges,40% of total billed charges,71.71,153.92,
FORCEPS HALO PKS CUT,5801832,CDM,272,RC,,,Outpatient,,,1425,1140.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1140,80,,912,percent of total billed charges,80% of total billed charges,531.1,37.27,,424.88,percent of total billed charges,37.27% of total billed charges,531.1,37.27,,424.88,percent of total billed charges,37.27% of total billed charges,531.1,37.27,,424.88,percent of total billed charges,37.27% 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,570,40,,456,percent of total billed charges,40% of total billed charges,531.1,1140,
RE ECH FLEX 45 WHITE,5801832,CDM,272,RC,,,Outpatient,,,528.48,422.78,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,422.78,80,,338.22,percent of total billed charges,80% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% 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,211.39,40,,169.11,percent of total billed charges,40% of total billed charges,196.96,422.78,
ENDOLOOP PDS II,5801832,CDM,272,RC,,,Outpatient,,,203.85,163.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.08,80,,130.46,percent of total billed charges,80% of total billed charges,75.97,37.27,,60.78,percent of total billed charges,37.27% of total billed charges,75.97,37.27,,60.78,percent of total billed charges,37.27% of total billed charges,75.97,37.27,,60.78,percent of total billed charges,37.27% 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,81.54,40,,65.23,percent of total billed charges,40% of total billed charges,75.97,163.08,
"PROLENE HERNIA LG 4""",5801832,CDM,272,RC,,,Outpatient,,,2752.84,2202.27,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2202.27,80,,1761.82,percent of total billed charges,80% of total billed charges,1025.98,37.27,,820.78,percent of total billed charges,37.27% of total billed charges,1025.98,37.27,,820.78,percent of total billed charges,37.27% of total billed charges,1025.98,37.27,,820.78,percent of total billed charges,37.27% 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,1101.14,40,,880.91,percent of total billed charges,40% of total billed charges,1025.98,2202.27,
PROLENE HERNIA EXT 4,5801832,CDM,272,RC,,,Outpatient,,,2752.84,2202.27,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2202.27,80,,1761.82,percent of total billed charges,80% of total billed charges,1025.98,37.27,,820.78,percent of total billed charges,37.27% of total billed charges,1025.98,37.27,,820.78,percent of total billed charges,37.27% of total billed charges,1025.98,37.27,,820.78,percent of total billed charges,37.27% 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,1101.14,40,,880.91,percent of total billed charges,40% of total billed charges,1025.98,2202.27,
RE ECH FLEX 45 BLUE,5801832,CDM,272,RC,,,Outpatient,,,528.48,422.78,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,422.78,80,,338.22,percent of total billed charges,80% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% 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,211.39,40,,169.11,percent of total billed charges,40% of total billed charges,196.96,422.78,
STAPL ECHELON FLX 45,5801832,CDM,272,RC,,,Outpatient,,,910.38,728.30,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,728.3,80,,582.64,percent of total billed charges,80% of total billed charges,339.3,37.27,,271.44,percent of total billed charges,37.27% of total billed charges,339.3,37.27,,271.44,percent of total billed charges,37.27% of total billed charges,339.3,37.27,,271.44,percent of total billed charges,37.27% 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,364.15,40,,291.32,percent of total billed charges,40% of total billed charges,339.3,728.3,
PRANDIN 2MG TAB,6400014,CDM,250,RC,,,Outpatient,,,11.4,9.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.12,80,,7.3,percent of total billed charges,80% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% of total billed charges,4.25,37.27,,3.4,percent of total billed charges,37.27% 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,4.56,40,,3.65,percent of total billed charges,40% of total billed charges,4.25,9.12,
CRTR-TMSN CLOSE SURE,5801832,CDM,272,RC,,,Outpatient,,,462,369.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,369.6,80,,295.68,percent of total billed charges,80% of total billed charges,172.19,37.27,,137.75,percent of total billed charges,37.27% of total billed charges,172.19,37.27,,137.75,percent of total billed charges,37.27% of total billed charges,172.19,37.27,,137.75,percent of total billed charges,37.27% 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,184.8,40,,147.84,percent of total billed charges,40% of total billed charges,172.19,369.6,
NDL 19 GUAGE KUMAR C,5801832,CDM,272,RC,,,Outpatient,,,168.75,135.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135,80,,108,percent of total billed charges,80% of total billed charges,62.89,37.27,,50.31,percent of total billed charges,37.27% of total billed charges,62.89,37.27,,50.31,percent of total billed charges,37.27% of total billed charges,62.89,37.27,,50.31,percent of total billed charges,37.27% 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,67.5,40,,54,percent of total billed charges,40% of total billed charges,62.89,135,
HYDROCODON/APAP5/325,5880901,CDM,637,RC,,,Outpatient,,,2.8,2.24,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.24,80,,1.79,percent of total billed charges,80% of total billed charges,1.04,37.27,,0.83,percent of total billed charges,37.27% of total billed charges,1.04,37.27,,0.83,percent of total billed charges,37.27% of total billed charges,1.04,37.27,,0.83,percent of total billed charges,37.27% 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,1.12,40,,0.9,percent of total billed charges,40% of total billed charges,1.04,2.24,
FORCEPS GYRUS OPEN,5801832,CDM,272,RC,,,Outpatient,,,870.48,696.38,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,696.38,80,,557.1,percent of total billed charges,80% of total billed charges,324.43,37.27,,259.54,percent of total billed charges,37.27% of total billed charges,324.43,37.27,,259.54,percent of total billed charges,37.27% of total billed charges,324.43,37.27,,259.54,percent of total billed charges,37.27% 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,348.19,40,,278.55,percent of total billed charges,40% of total billed charges,324.43,696.38,
KIT CT INJECTION,5801832,CDM,272,RC,,,Outpatient,,,68.5,54.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.8,80,,43.84,percent of total billed charges,80% of total billed charges,25.53,37.27,,20.42,percent of total billed charges,37.27% of total billed charges,25.53,37.27,,20.42,percent of total billed charges,37.27% of total billed charges,25.53,37.27,,20.42,percent of total billed charges,37.27% 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,27.4,40,,21.92,percent of total billed charges,40% of total billed charges,25.53,54.8,
KIT MRI,5801832,CDM,272,RC,,,Outpatient,,,71.5,57.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.2,80,,45.76,percent of total billed charges,80% of total billed charges,26.65,37.27,,21.32,percent of total billed charges,37.27% of total billed charges,26.65,37.27,,21.32,percent of total billed charges,37.27% of total billed charges,26.65,37.27,,21.32,percent of total billed charges,37.27% 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,28.6,40,,22.88,percent of total billed charges,40% of total billed charges,26.65,57.2,
TROCAR XCEL 12 X 100,5801832,CDM,272,RC,,,Outpatient,,,293.63,234.90,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.9,80,,187.92,percent of total billed charges,80% of total billed charges,109.44,37.27,,87.55,percent of total billed charges,37.27% of total billed charges,109.44,37.27,,87.55,percent of total billed charges,37.27% of total billed charges,109.44,37.27,,87.55,percent of total billed charges,37.27% 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,117.45,40,,93.96,percent of total billed charges,40% of total billed charges,109.44,234.9,
LO-ESTRIN,6400014,CDM,250,RC,,,Outpatient,,,12.1,9.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.68,80,,7.74,percent of total billed charges,80% of total billed charges,4.51,37.27,,3.61,percent of total billed charges,37.27% of total billed charges,4.51,37.27,,3.61,percent of total billed charges,37.27% of total billed charges,4.51,37.27,,3.61,percent of total billed charges,37.27% 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,4.84,40,,3.87,percent of total billed charges,40% of total billed charges,4.51,9.68,
LOESTRIN 1.5/30,6400014,CDM,250,RC,,,Outpatient,,,3.5,2.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
RE ECH FLEX 45 GRAY,5801832,CDM,272,RC,,,Outpatient,,,528.48,422.78,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,422.78,80,,338.22,percent of total billed charges,80% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% 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,211.39,40,,169.11,percent of total billed charges,40% of total billed charges,196.96,422.78,
STAPL ECH FLX 45PWRD,5801832,CDM,272,RC,,,Outpatient,,,1035.18,828.14,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,828.14,80,,662.51,percent of total billed charges,80% of total billed charges,385.81,37.27,,308.65,percent of total billed charges,37.27% of total billed charges,385.81,37.27,,308.65,percent of total billed charges,37.27% of total billed charges,385.81,37.27,,308.65,percent of total billed charges,37.27% 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,414.07,40,,331.26,percent of total billed charges,40% of total billed charges,385.81,828.14,
KIDNEY SHAPE BALLOON,5801832,CDM,272,RC,,,Outpatient,,,1128.54,902.83,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,902.83,80,,722.26,percent of total billed charges,80% of total billed charges,420.61,37.27,,336.49,percent of total billed charges,37.27% of total billed charges,420.61,37.27,,336.49,percent of total billed charges,37.27% of total billed charges,420.61,37.27,,336.49,percent of total billed charges,37.27% 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,451.42,40,,361.14,percent of total billed charges,40% of total billed charges,420.61,902.83,
SEPRA FILM,5801832,CDM,272,RC,,,Outpatient,,,807,645.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,645.6,80,,516.48,percent of total billed charges,80% of total billed charges,300.77,37.27,,240.62,percent of total billed charges,37.27% of total billed charges,300.77,37.27,,240.62,percent of total billed charges,37.27% of total billed charges,300.77,37.27,,240.62,percent of total billed charges,37.27% 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,322.8,40,,258.24,percent of total billed charges,40% of total billed charges,300.77,645.6,
IMMUNOHISTOCHEM II,7012032,CDM,300,RC,88343,HCPCS,Outpatient,,,85.01,68.01,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.01,80,,54.41,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% 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,34,40,,27.2,percent of total billed charges,40% of total billed charges,31.68,68.01,
PHYSIOMESH 25-25 OVA,5801832,CDM,272,RC,,,Outpatient,,,3276.95,2621.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2621.56,80,,2097.25,percent of total billed charges,80% of total billed charges,1221.32,37.27,,977.06,percent of total billed charges,37.27% of total billed charges,1221.32,37.27,,977.06,percent of total billed charges,37.27% of total billed charges,1221.32,37.27,,977.06,percent of total billed charges,37.27% 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,1310.78,40,,1048.62,percent of total billed charges,40% of total billed charges,1221.32,2621.56,
PROTRACTOR SMALL,5801832,CDM,272,RC,,,Outpatient,,,2008.8,1607.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1607.04,80,,1285.63,percent of total billed charges,80% of total billed charges,748.68,37.27,,598.94,percent of total billed charges,37.27% of total billed charges,748.68,37.27,,598.94,percent of total billed charges,37.27% of total billed charges,748.68,37.27,,598.94,percent of total billed charges,37.27% 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,803.52,40,,642.82,percent of total billed charges,40% of total billed charges,748.68,1607.04,
CSF ARBOVIRUS IGG,7012032,CDM,300,RC,,,Outpatient,,,49.1,39.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,39.28,80,,31.42,percent of total billed charges,80% of total billed charges,18.3,37.27,,14.64,percent of total billed charges,37.27% of total billed charges,18.3,37.27,,14.64,percent of total billed charges,37.27% of total billed charges,18.3,37.27,,14.64,percent of total billed charges,37.27% 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,19.64,40,,15.71,percent of total billed charges,40% of total billed charges,18.3,39.28,
NITROGLYCERIN 50MG,6065130,CDM,636,RC,J2305,HCPCS,Outpatient,,,92.2,73.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.76,80,,59.01,percent of total billed charges,80% of total billed charges,34.36,37.27,,27.49,percent of total billed charges,37.27% of total billed charges,34.36,37.27,,27.49,percent of total billed charges,37.27% of total billed charges,34.36,37.27,,27.49,percent of total billed charges,37.27% of total billed charges,1.41,100,,,fee schedule,100% of APC rate,1.41,100,,,fee schedule,100% of APC rate,1.41,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1.41,100,,,fee schedule,100% of APC rate,1.41,100,,,fee schedule,100% of APC rate,1.41,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.88,40,,29.5,percent of total billed charges,40% of total billed charges,1.41,73.76,
VENTRALT HERNIA 4X6,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,2764,2211.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2211.2,80,,1768.96,percent of total billed charges,80% of total billed charges,1030.14,37.27,,824.11,percent of total billed charges,37.27% of total billed charges,1030.14,37.27,,824.11,percent of total billed charges,37.27% of total billed charges,1030.14,37.27,,824.11,percent of total billed charges,37.27% 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,1105.6,40,,884.48,percent of total billed charges,40% of total billed charges,1030.14,2211.2,
VENTRALEX HERNIA 4X5,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,2764,2211.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2211.2,80,,1768.96,percent of total billed charges,80% of total billed charges,1030.14,37.27,,824.11,percent of total billed charges,37.27% of total billed charges,1030.14,37.27,,824.11,percent of total billed charges,37.27% of total billed charges,1030.14,37.27,,824.11,percent of total billed charges,37.27% 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,1105.6,40,,884.48,percent of total billed charges,40% of total billed charges,1030.14,2211.2,
BUPIVACAIN/EPI 0.25%,6065130,CDM,636,RC,J0665,HCPCS,Outpatient,,,69.65,55.72,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.72,80,,44.58,percent of total billed charges,80% of total billed charges,25.96,37.27,,20.77,percent of total billed charges,37.27% of total billed charges,25.96,37.27,,20.77,percent of total billed charges,37.27% of total billed charges,25.96,37.27,,20.77,percent of total billed charges,37.27% of total billed charges,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.86,40,,22.29,percent of total billed charges,40% of total billed charges,0.01,55.72,
OXYCODONE 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
TISSUE EXAM I,7012032,CDM,300,RC,88300,HCPCS,Outpatient,,,52.13,41.70,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.7,80,,33.36,percent of total billed charges,80% of total billed charges,19.43,37.27,,15.54,percent of total billed charges,37.27% of total billed charges,19.43,37.27,,15.54,percent of total billed charges,37.27% of total billed charges,19.43,37.27,,15.54,percent of total billed charges,37.27% of total billed charges,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,15.34,145,,,fee schedule,145% of CMS fee schedule,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.85,40,,16.68,percent of total billed charges,40% of total billed charges,15.34,41.7,
LEVOTHYROXINE 100MCG,6400014,CDM,250,RC,,,Outpatient,,,375.65,300.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300.52,80,,240.42,percent of total billed charges,80% of total billed charges,140,37.27,,112,percent of total billed charges,37.27% of total billed charges,140,37.27,,112,percent of total billed charges,37.27% of total billed charges,140,37.27,,112,percent of total billed charges,37.27% 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,150.26,40,,120.21,percent of total billed charges,40% of total billed charges,140,300.52,
REGIONAL BLK NDL 40M,5801832,CDM,272,RC,,,Outpatient,,,532,425.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% 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,212.8,40,,170.24,percent of total billed charges,40% of total billed charges,198.28,425.6,
REGIONAL BLK NDL 80M,5801832,CDM,272,RC,,,Outpatient,,,576,460.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,460.8,80,,368.64,percent of total billed charges,80% of total billed charges,214.68,37.27,,171.74,percent of total billed charges,37.27% of total billed charges,214.68,37.27,,171.74,percent of total billed charges,37.27% of total billed charges,214.68,37.27,,171.74,percent of total billed charges,37.27% 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,230.4,40,,184.32,percent of total billed charges,40% of total billed charges,214.68,460.8,
REGIONAL BLK NDL 100,5801832,CDM,272,RC,,,Outpatient,,,596,476.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,476.8,80,,381.44,percent of total billed charges,80% of total billed charges,222.13,37.27,,177.7,percent of total billed charges,37.27% of total billed charges,222.13,37.27,,177.7,percent of total billed charges,37.27% of total billed charges,222.13,37.27,,177.7,percent of total billed charges,37.27% 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,238.4,40,,190.72,percent of total billed charges,40% of total billed charges,222.13,476.8,
PEDI CALCIUM/PTH,7012032,CDM,300,RC,,,Outpatient,,,28,22.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.4,80,,17.92,percent of total billed charges,80% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% of total billed charges,10.44,37.27,,8.35,percent of total billed charges,37.27% 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,11.2,40,,8.96,percent of total billed charges,40% of total billed charges,10.44,22.4,
KII OPTICAL ACCESS,5801832,CDM,272,RC,,,Outpatient,,,200,160.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160,80,,128,percent of total billed charges,80% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% 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,80,40,,64,percent of total billed charges,40% of total billed charges,74.54,160,
PROSTIGMINE 1:2000,6065130,CDM,636,RC,J2710,HCPCS,Outpatient,,,58.15,46.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.52,80,,37.22,percent of total billed charges,80% of total billed charges,21.67,37.27,,17.34,percent of total billed charges,37.27% of total billed charges,21.67,37.27,,17.34,percent of total billed charges,37.27% of total billed charges,21.67,37.27,,17.34,percent of total billed charges,37.27% 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,23.26,40,,18.61,percent of total billed charges,40% of total billed charges,21.67,46.52,
"CYTOLOGY,TC OTHER",7012032,CDM,300,RC,88160,HCPCS,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,70.02,145,,,fee schedule,145% of CMS fee schedule,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,24.55,70.02,
VANDAZOLE 0.75% VAG,6400014,CDM,250,RC,,,Outpatient,,,474.4,379.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,379.52,80,,303.62,percent of total billed charges,80% of total billed charges,176.81,37.27,,141.45,percent of total billed charges,37.27% of total billed charges,176.81,37.27,,141.45,percent of total billed charges,37.27% of total billed charges,176.81,37.27,,141.45,percent of total billed charges,37.27% 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,189.76,40,,151.81,percent of total billed charges,40% of total billed charges,176.81,379.52,
"ZINC,URINE",7012032,CDM,300,RC,,,Outpatient,,,144.13,115.30,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.3,80,,92.24,percent of total billed charges,80% of total billed charges,53.72,37.27,,42.98,percent of total billed charges,37.27% of total billed charges,53.72,37.27,,42.98,percent of total billed charges,37.27% of total billed charges,53.72,37.27,,42.98,percent of total billed charges,37.27% 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,57.65,40,,46.12,percent of total billed charges,40% of total billed charges,53.72,115.3,
HIV CONFIRMATION,7012032,CDM,300,RC,,,Outpatient,,,36.3,29.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.04,80,,23.23,percent of total billed charges,80% of total billed charges,13.53,37.27,,10.82,percent of total billed charges,37.27% of total billed charges,13.53,37.27,,10.82,percent of total billed charges,37.27% of total billed charges,13.53,37.27,,10.82,percent of total billed charges,37.27% 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,14.52,40,,11.62,percent of total billed charges,40% of total billed charges,13.53,29.04,
TUBERSOL 0.1ML,6400014,CDM,250,RC,,,Outpatient,,,36.7,29.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.36,80,,23.49,percent of total billed charges,80% of total billed charges,13.68,37.27,,10.94,percent of total billed charges,37.27% of total billed charges,13.68,37.27,,10.94,percent of total billed charges,37.27% of total billed charges,13.68,37.27,,10.94,percent of total billed charges,37.27% 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,14.68,40,,11.74,percent of total billed charges,40% of total billed charges,13.68,29.36,
CANDIN SKIN TEST,6400014,CDM,250,RC,,,Outpatient,,,121.1,96.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.88,80,,77.5,percent of total billed charges,80% of total billed charges,45.13,37.27,,36.1,percent of total billed charges,37.27% of total billed charges,45.13,37.27,,36.1,percent of total billed charges,37.27% of total billed charges,45.13,37.27,,36.1,percent of total billed charges,37.27% 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,48.44,40,,38.75,percent of total billed charges,40% of total billed charges,45.13,96.88,
GOLYTELY 4000ML,5880901,CDM,637,RC,,,Outpatient,,,101.9,81.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,81.52,80,,65.22,percent of total billed charges,80% of total billed charges,37.98,37.27,,30.38,percent of total billed charges,37.27% of total billed charges,37.98,37.27,,30.38,percent of total billed charges,37.27% of total billed charges,37.98,37.27,,30.38,percent of total billed charges,37.27% 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,40.76,40,,32.61,percent of total billed charges,40% of total billed charges,37.98,81.52,
MARCAINE 0.5% MPF,6400014,CDM,250,RC,,,Outpatient,,,0.01,0.01,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,80,,0.01,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,0.01,0.01,
SENSORCAINE MPF 0.5%,6065130,CDM,636,RC,J0665,HCPCS,Outpatient,,,18.65,14.92,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.92,80,,11.94,percent of total billed charges,80% of total billed charges,6.95,37.27,,5.56,percent of total billed charges,37.27% of total billed charges,6.95,37.27,,5.56,percent of total billed charges,37.27% of total billed charges,6.95,37.27,,5.56,percent of total billed charges,37.27% of total billed charges,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.46,40,,5.97,percent of total billed charges,40% of total billed charges,0.01,14.92,
TB SKIN TEST,7012032,CDM,300,RC,86580,HCPCS,Outpatient,,,46,36.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,13.22,145,,,fee schedule,145% of CMS fee schedule,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,13.22,36.8,
DRUG 10 PANEL W/ALCO,7012032,CDM,300,RC,G0431,HCPCS,Outpatient,,,122.52,98.02,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.02,80,,78.42,percent of total billed charges,80% of total billed charges,45.66,37.27,,36.53,percent of total billed charges,37.27% of total billed charges,45.66,37.27,,36.53,percent of total billed charges,37.27% of total billed charges,45.66,37.27,,36.53,percent of total billed charges,37.27% 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,49.01,40,,39.21,percent of total billed charges,40% of total billed charges,45.66,98.02,
SILVADENE CREAM 20GM,6400014,CDM,250,RC,,,Outpatient,,,31.9,25.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.52,80,,20.42,percent of total billed charges,80% of total billed charges,11.89,37.27,,9.51,percent of total billed charges,37.27% of total billed charges,11.89,37.27,,9.51,percent of total billed charges,37.27% of total billed charges,11.89,37.27,,9.51,percent of total billed charges,37.27% 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,12.76,40,,10.21,percent of total billed charges,40% of total billed charges,11.89,25.52,
LACTULOSE (PER OZ),5880901,CDM,637,RC,,,Outpatient,,,7.85,6.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.28,80,,5.02,percent of total billed charges,80% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% 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,3.14,40,,2.51,percent of total billed charges,40% of total billed charges,2.93,6.28,
ORAP 1MG,6400014,CDM,250,RC,,,Outpatient,,,7.2,5.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.76,80,,4.61,percent of total billed charges,80% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% of total billed charges,2.68,37.27,,2.14,percent of total billed charges,37.27% 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,2.88,40,,2.3,percent of total billed charges,40% of total billed charges,2.68,5.76,
NS 250ML ADVANTAGE,6400014,CDM,250,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
HEMOGLOBIN FRAC PROF,7012032,CDM,300,RC,,,Outpatient,,,31,24.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.8,80,,19.84,percent of total billed charges,80% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% of total billed charges,11.55,37.27,,9.24,percent of total billed charges,37.27% 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,12.4,40,,9.92,percent of total billed charges,40% of total billed charges,11.55,24.8,
SPS SUPSENSION 60ML,6400014,CDM,250,RC,,,Outpatient,,,105.7,84.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.56,80,,67.65,percent of total billed charges,80% of total billed charges,39.39,37.27,,31.51,percent of total billed charges,37.27% of total billed charges,39.39,37.27,,31.51,percent of total billed charges,37.27% of total billed charges,39.39,37.27,,31.51,percent of total billed charges,37.27% 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,42.28,40,,33.82,percent of total billed charges,40% of total billed charges,39.39,84.56,
RHOPHYLAC-RHOD300MCG,6065130,CDM,636,RC,J2790,HCPCS,Outpatient,,,168.98,135.18,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.18,80,,108.14,percent of total billed charges,80% of total billed charges,62.98,37.27,,50.38,percent of total billed charges,37.27% of total billed charges,62.98,37.27,,50.38,percent of total billed charges,37.27% of total billed charges,62.98,37.27,,50.38,percent of total billed charges,37.27% 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,67.59,40,,54.07,percent of total billed charges,40% of total billed charges,62.98,135.18,
WHITE PETROLATUM UD,6400014,CDM,250,RC,,,Outpatient,,,3.25,2.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.6,80,,2.08,percent of total billed charges,80% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% 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,1.3,40,,1.04,percent of total billed charges,40% of total billed charges,1.21,2.6,
GONAK OPTH 2.5% 15ML,5880901,CDM,637,RC,,,Outpatient,,,82.5,66.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66,80,,52.8,percent of total billed charges,80% of total billed charges,30.75,37.27,,24.6,percent of total billed charges,37.27% of total billed charges,30.75,37.27,,24.6,percent of total billed charges,37.27% of total billed charges,30.75,37.27,,24.6,percent of total billed charges,37.27% 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,33,40,,26.4,percent of total billed charges,40% of total billed charges,30.75,66,
PAMIDRONATE 30MG INJ,6065130,CDM,636,RC,J2430,HCPCS,Outpatient,,,110.5,88.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.4,80,,70.72,percent of total billed charges,80% of total billed charges,41.18,37.27,,32.94,percent of total billed charges,37.27% of total billed charges,41.18,37.27,,32.94,percent of total billed charges,37.27% of total billed charges,41.18,37.27,,32.94,percent of total billed charges,37.27% 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,44.2,40,,35.36,percent of total billed charges,40% of total billed charges,41.18,88.4,
BREVIBLOC PREMIX,6065130,CDM,636,RC,J1805,HCPCS,Outpatient,,,1689.25,1351.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1351.4,80,,1081.12,percent of total billed charges,80% of total billed charges,629.58,37.27,,503.66,percent of total billed charges,37.27% of total billed charges,629.58,37.27,,503.66,percent of total billed charges,37.27% of total billed charges,629.58,37.27,,503.66,percent of total billed charges,37.27% of total billed charges,0.19,100,,,fee schedule,100% of APC rate,0.19,100,,,fee schedule,100% of APC rate,0.19,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.19,100,,,fee schedule,100% of APC rate,0.19,100,,,fee schedule,100% of APC rate,0.19,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,675.7,40,,540.56,percent of total billed charges,40% of total billed charges,0.19,1351.4,
INTRODUCER BARD 10FR,8605396,CDM,278,RC,C1894,HCPCS,Outpatient,,,427.5,342.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,342,80,,273.6,percent of total billed charges,80% of total billed charges,159.33,37.27,,127.46,percent of total billed charges,37.27% of total billed charges,159.33,37.27,,127.46,percent of total billed charges,37.27% of total billed charges,159.33,37.27,,127.46,percent of total billed charges,37.27% 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,171,40,,136.8,percent of total billed charges,40% of total billed charges,159.33,342,
POWER PORT 9.6,8605396,CDM,278,RC,C1788,HCPCS,Outpatient,,,1582,1265.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1265.6,80,,1012.48,percent of total billed charges,80% of total billed charges,589.61,37.27,,471.69,percent of total billed charges,37.27% of total billed charges,589.61,37.27,,471.69,percent of total billed charges,37.27% of total billed charges,589.61,37.27,,471.69,percent of total billed charges,37.27% 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,632.8,40,,506.24,percent of total billed charges,40% of total billed charges,589.61,1265.6,
SHOX-DNADX,7012032,CDM,300,RC,81479,HCPCS,Outpatient,,,750,600.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600,80,,480,percent of total billed charges,80% of total billed charges,279.53,37.27,,223.62,percent of total billed charges,37.27% of total billed charges,279.53,37.27,,223.62,percent of total billed charges,37.27% of total billed charges,279.53,37.27,,223.62,percent of total billed charges,37.27% 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,300,40,,240,percent of total billed charges,40% of total billed charges,279.53,600,
DRESS WD VAC SILV LG,5801832,CDM,272,RC,,,Outpatient,,,373.68,298.94,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,298.94,80,,239.15,percent of total billed charges,80% of total billed charges,139.27,37.27,,111.42,percent of total billed charges,37.27% of total billed charges,139.27,37.27,,111.42,percent of total billed charges,37.27% of total billed charges,139.27,37.27,,111.42,percent of total billed charges,37.27% 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,149.47,40,,119.58,percent of total billed charges,40% of total billed charges,139.27,298.94,
CAN WD VAC 500ML/GEL,5801832,CDM,272,RC,,,Outpatient,,,206.05,164.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.84,80,,131.87,percent of total billed charges,80% of total billed charges,76.79,37.27,,61.43,percent of total billed charges,37.27% of total billed charges,76.79,37.27,,61.43,percent of total billed charges,37.27% of total billed charges,76.79,37.27,,61.43,percent of total billed charges,37.27% 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,82.42,40,,65.94,percent of total billed charges,40% of total billed charges,76.79,164.84,
IMMUNOFLUOR STUDY AN,7012032,CDM,300,RC,88346,HCPCS,Outpatient,,,430.86,344.69,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344.69,80,,275.75,percent of total billed charges,80% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,146.55,145,,,fee schedule,145% of CMS fee schedule,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.34,40,,137.87,percent of total billed charges,40% of total billed charges,140.82,344.69,
COMBIVENT RESPIMAT I,5880901,CDM,637,RC,,,Outpatient,,,1532.6,1226.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1226.08,80,,980.86,percent of total billed charges,80% of total billed charges,571.2,37.27,,456.96,percent of total billed charges,37.27% of total billed charges,571.2,37.27,,456.96,percent of total billed charges,37.27% of total billed charges,571.2,37.27,,456.96,percent of total billed charges,37.27% 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,613.04,40,,490.43,percent of total billed charges,40% of total billed charges,571.2,1226.08,
DOXYCYCLINE 100MG TB,5880901,CDM,637,RC,,,Outpatient,,,16.75,13.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.4,80,,10.72,percent of total billed charges,80% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% of total billed charges,6.24,37.27,,4.99,percent of total billed charges,37.27% 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,6.7,40,,5.36,percent of total billed charges,40% of total billed charges,6.24,13.4,
BROMOCRIPTINE 5MG TB,5880901,CDM,637,RC,,,Outpatient,,,31.75,25.40,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.4,80,,20.32,percent of total billed charges,80% of total billed charges,11.83,37.27,,9.46,percent of total billed charges,37.27% of total billed charges,11.83,37.27,,9.46,percent of total billed charges,37.27% of total billed charges,11.83,37.27,,9.46,percent of total billed charges,37.27% 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,12.7,40,,10.16,percent of total billed charges,40% of total billed charges,11.83,25.4,
ENGERIX-B 10MCG SYR,6400014,CDM,250,RC,,,Outpatient,,,115.75,92.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.6,80,,74.08,percent of total billed charges,80% of total billed charges,43.14,37.27,,34.51,percent of total billed charges,37.27% of total billed charges,43.14,37.27,,34.51,percent of total billed charges,37.27% of total billed charges,43.14,37.27,,34.51,percent of total billed charges,37.27% 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,46.3,40,,37.04,percent of total billed charges,40% of total billed charges,43.14,92.6,
IPRA/ALBUTEROL INH 3,5880901,CDM,637,RC,,,Outpatient,,,7.5,6.00,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6,80,,4.8,percent of total billed charges,80% of total billed charges,2.8,37.27,,2.24,percent of total billed charges,37.27% of total billed charges,2.8,37.27,,2.24,percent of total billed charges,37.27% of total billed charges,2.8,37.27,,2.24,percent of total billed charges,37.27% 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,3,40,,2.4,percent of total billed charges,40% of total billed charges,2.8,6,
TORCH PANEL NEW,7012032,CDM,300,RC,,,Outpatient,,,822,657.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,657.6,80,,526.08,percent of total billed charges,80% of total billed charges,306.36,37.27,,245.09,percent of total billed charges,37.27% of total billed charges,306.36,37.27,,245.09,percent of total billed charges,37.27% of total billed charges,306.36,37.27,,245.09,percent of total billed charges,37.27% 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,328.8,40,,263.04,percent of total billed charges,40% of total billed charges,306.36,657.6,
HEMOGLOBIN FRAC PROF,7012032,CDM,300,RC,,,Outpatient,,,93.4,74.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.72,80,,59.78,percent of total billed charges,80% of total billed charges,34.81,37.27,,27.85,percent of total billed charges,37.27% of total billed charges,34.81,37.27,,27.85,percent of total billed charges,37.27% of total billed charges,34.81,37.27,,27.85,percent of total billed charges,37.27% 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,37.36,40,,29.89,percent of total billed charges,40% of total billed charges,34.81,74.72,
BUPIVACAINE 0.75%INJ,6065130,CDM,636,RC,J0665,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,0.01,10.16,
SUTURE CT-1 YY30G,5801832,CDM,272,RC,,,Outpatient,,,33.6,26.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.88,80,,21.5,percent of total billed charges,80% of total billed charges,12.52,37.27,,10.02,percent of total billed charges,37.27% of total billed charges,12.52,37.27,,10.02,percent of total billed charges,37.27% of total billed charges,12.52,37.27,,10.02,percent of total billed charges,37.27% 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,13.44,40,,10.75,percent of total billed charges,40% of total billed charges,12.52,26.88,
VITAMIN B12 100MCG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
NEUPRO 2MG/24HR PAT,6400014,CDM,250,RC,,,Outpatient,,,104.85,83.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.88,80,,67.1,percent of total billed charges,80% of total billed charges,39.08,37.27,,31.26,percent of total billed charges,37.27% of total billed charges,39.08,37.27,,31.26,percent of total billed charges,37.27% of total billed charges,39.08,37.27,,31.26,percent of total billed charges,37.27% 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,41.94,40,,33.55,percent of total billed charges,40% of total billed charges,39.08,83.88,
TB SKIN TEST,5612346,CDM,761,RC,86580,HCPCS,Outpatient,,,46,36.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.8,80,,29.44,percent of total billed charges,80% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,17.14,37.27,,13.71,percent of total billed charges,37.27% of total billed charges,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,13.22,145,,,fee schedule,145% of CMS fee schedule,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,24.55,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18.4,40,,14.72,percent of total billed charges,40% of total billed charges,13.22,36.8,
INCUBATION W/INHIBIT,7000169,CDM,302,RC,86977,HCPCS,Outpatient,,,258.36,206.69,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,206.69,80,,165.35,percent of total billed charges,80% of total billed charges,96.29,37.27,,77.03,percent of total billed charges,37.27% of total billed charges,96.29,37.27,,77.03,percent of total billed charges,37.27% of total billed charges,96.29,37.27,,77.03,percent of total billed charges,37.27% of total billed charges,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.34,40,,82.67,percent of total billed charges,40% of total billed charges,96.29,206.69,
IN/OUT CATH,5612346,CDM,761,RC,51701,HCPCS,Outpatient,,,136,108.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,36.02,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,36.02,108.8,
AMNIOCENTESIS TRAY,5801832,CDM,272,RC,,,Outpatient,,,45.85,36.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.68,80,,29.34,percent of total billed charges,80% of total billed charges,17.09,37.27,,13.67,percent of total billed charges,37.27% of total billed charges,17.09,37.27,,13.67,percent of total billed charges,37.27% of total billed charges,17.09,37.27,,13.67,percent of total billed charges,37.27% 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,18.34,40,,14.67,percent of total billed charges,40% of total billed charges,17.09,36.68,
EXPAREL 1.3% INJ,6065130,CDM,636,RC,C9290,HCPCS,Outpatient,,,1644.4,1315.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1315.52,80,,1052.42,percent of total billed charges,80% of total billed charges,612.87,37.27,,490.3,percent of total billed charges,37.27% of total billed charges,612.87,37.27,,490.3,percent of total billed charges,37.27% of total billed charges,612.87,37.27,,490.3,percent of total billed charges,37.27% 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,657.76,40,,526.21,percent of total billed charges,40% of total billed charges,612.87,1315.52,
TROCAR 5MMX150MM B5X,5801832,CDM,272,RC,,,Outpatient,,,225,180.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,80,,144,percent of total billed charges,80% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% 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,90,40,,72,percent of total billed charges,40% of total billed charges,83.86,180,
NIF OMETER,5801832,CDM,272,RC,,,Outpatient,,,69,55.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% 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,27.6,40,,22.08,percent of total billed charges,40% of total billed charges,25.72,55.2,
NIF PER DAY,7439094,CDM,410,RC,94004,HCPCS,Outpatient,,,138,110.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.4,80,,88.32,percent of total billed charges,80% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.63,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.2,40,,44.16,percent of total billed charges,40% of total billed charges,51.43,110.4,
HEPARIN 1UN/ML SYR,6065130,CDM,636,RC,J1642,HCPCS,Outpatient,,,12.9,10.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.32,80,,8.26,percent of total billed charges,80% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% 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,5.16,40,,4.13,percent of total billed charges,40% of total billed charges,4.81,10.32,
ECH RELOAD GOLD P/NE,5801832,CDM,272,RC,,,Outpatient,,,528.48,422.78,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,422.78,80,,338.22,percent of total billed charges,80% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% 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,211.39,40,,169.11,percent of total billed charges,40% of total billed charges,196.96,422.78,
ECH RELOAD GREEN P/N,5801832,CDM,272,RC,,,Outpatient,,,528.48,422.78,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,422.78,80,,338.22,percent of total billed charges,80% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% of total billed charges,196.96,37.27,,157.57,percent of total billed charges,37.27% 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,211.39,40,,169.11,percent of total billed charges,40% of total billed charges,196.96,422.78,
FRACTIONATED BILIRUB,7012032,CDM,300,RC,,,Outpatient,,,40,32.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% 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,16,40,,12.8,percent of total billed charges,40% of total billed charges,14.91,32,
DIBUCAINE OINT 1%,5880901,CDM,637,RC,,,Outpatient,,,26.75,21.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.4,80,,17.12,percent of total billed charges,80% of total billed charges,9.97,37.27,,7.98,percent of total billed charges,37.27% of total billed charges,9.97,37.27,,7.98,percent of total billed charges,37.27% of total billed charges,9.97,37.27,,7.98,percent of total billed charges,37.27% 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,10.7,40,,8.56,percent of total billed charges,40% of total billed charges,9.97,21.4,
GELFOAM SIZE 200,5880901,CDM,637,RC,,,Outpatient,,,309.05,247.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,247.24,80,,197.79,percent of total billed charges,80% of total billed charges,115.18,37.27,,92.14,percent of total billed charges,37.27% of total billed charges,115.18,37.27,,92.14,percent of total billed charges,37.27% of total billed charges,115.18,37.27,,92.14,percent of total billed charges,37.27% 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,123.62,40,,98.9,percent of total billed charges,40% of total billed charges,115.18,247.24,
TESTOSTRONE,7012032,CDM,300,RC,,,Outpatient,,,426,340.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,340.8,80,,272.64,percent of total billed charges,80% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% 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,170.4,40,,136.32,percent of total billed charges,40% of total billed charges,158.77,340.8,
HEP B CORE AB IGG/IG,7012032,CDM,300,RC,,,Outpatient,,,133,106.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.4,80,,85.12,percent of total billed charges,80% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% of total billed charges,49.57,37.27,,39.66,percent of total billed charges,37.27% 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,53.2,40,,42.56,percent of total billed charges,40% of total billed charges,49.57,106.4,
HYDROCOD/APAP LIQUID,5880901,CDM,637,RC,,,Outpatient,,,3.5,2.80,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.8,80,,2.24,percent of total billed charges,80% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% of total billed charges,1.3,37.27,,1.04,percent of total billed charges,37.27% 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,1.4,40,,1.12,percent of total billed charges,40% of total billed charges,1.3,2.8,
AQUAPHOR HEALING OIN,6400014,CDM,250,RC,,,Outpatient,,,16.47,13.18,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.18,80,,10.54,percent of total billed charges,80% of total billed charges,6.14,37.27,,4.91,percent of total billed charges,37.27% of total billed charges,6.14,37.27,,4.91,percent of total billed charges,37.27% of total billed charges,6.14,37.27,,4.91,percent of total billed charges,37.27% 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,6.59,40,,5.27,percent of total billed charges,40% of total billed charges,6.14,13.18,
VARIVAX (VARICELLA),6400014,CDM,250,RC,,,Outpatient,,,431.6,345.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.28,80,,276.22,percent of total billed charges,80% of total billed charges,160.86,37.27,,128.69,percent of total billed charges,37.27% of total billed charges,160.86,37.27,,128.69,percent of total billed charges,37.27% of total billed charges,160.86,37.27,,128.69,percent of total billed charges,37.27% 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,172.64,40,,138.11,percent of total billed charges,40% of total billed charges,160.86,345.28,
ATIVAN ORAL,6400014,CDM,250,RC,,,Outpatient,,,7.6,6.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
NASH FIBROSURE,7012032,CDM,300,RC,,,Outpatient,,,360,288.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,80,,230.4,percent of total billed charges,80% of total billed charges,134.17,37.27,,107.34,percent of total billed charges,37.27% of total billed charges,134.17,37.27,,107.34,percent of total billed charges,37.27% of total billed charges,134.17,37.27,,107.34,percent of total billed charges,37.27% 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,144,40,,115.2,percent of total billed charges,40% of total billed charges,134.17,288,
DERMA FLEX,5801832,CDM,272,RC,,,Outpatient,,,72.5,58.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58,80,,46.4,percent of total billed charges,80% of total billed charges,27.02,37.27,,21.62,percent of total billed charges,37.27% of total billed charges,27.02,37.27,,21.62,percent of total billed charges,37.27% of total billed charges,27.02,37.27,,21.62,percent of total billed charges,37.27% 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,29,40,,23.2,percent of total billed charges,40% of total billed charges,27.02,58,
HERPES SIMPLEX&ZOSTE,7012032,CDM,300,RC,,,Outpatient,,,143.38,114.70,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.7,80,,91.76,percent of total billed charges,80% of total billed charges,53.44,37.27,,42.75,percent of total billed charges,37.27% of total billed charges,53.44,37.27,,42.75,percent of total billed charges,37.27% of total billed charges,53.44,37.27,,42.75,percent of total billed charges,37.27% 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,57.35,40,,45.88,percent of total billed charges,40% of total billed charges,53.44,114.7,
INJECTAFER 1ME,6065130,CDM,636,RC,J1439,HCPCS,Outpatient,,,3337,2669.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2669.6,80,,2135.68,percent of total billed charges,80% of total billed charges,1243.7,37.27,,994.96,percent of total billed charges,37.27% of total billed charges,1243.7,37.27,,994.96,percent of total billed charges,37.27% of total billed charges,1243.7,37.27,,994.96,percent of total billed charges,37.27% of total billed charges,1.1,100,,,fee schedule,100% of APC rate,1.1,100,,,fee schedule,100% of APC rate,1.1,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1.1,100,,,fee schedule,100% of APC rate,1.1,100,,,fee schedule,100% of APC rate,1.1,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1334.8,40,,1067.84,percent of total billed charges,40% of total billed charges,1.1,2669.6,
ALLEVYN LIFE 8 X 8,5801832,CDM,272,RC,,,Outpatient,,,33.35,26.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.68,80,,21.34,percent of total billed charges,80% of total billed charges,12.43,37.27,,9.94,percent of total billed charges,37.27% of total billed charges,12.43,37.27,,9.94,percent of total billed charges,37.27% of total billed charges,12.43,37.27,,9.94,percent of total billed charges,37.27% 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,13.34,40,,10.67,percent of total billed charges,40% of total billed charges,12.43,26.68,
ALLEVYN LIFE SACRUM6,5801832,CDM,272,RC,,,Outpatient,,,33.9,27.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.12,80,,21.7,percent of total billed charges,80% of total billed charges,12.63,37.27,,10.1,percent of total billed charges,37.27% of total billed charges,12.63,37.27,,10.1,percent of total billed charges,37.27% of total billed charges,12.63,37.27,,10.1,percent of total billed charges,37.27% 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,13.56,40,,10.85,percent of total billed charges,40% of total billed charges,12.63,27.12,
TRAVATAN Z OPTH,6400014,CDM,250,RC,,,Outpatient,,,356.7,285.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,285.36,80,,228.29,percent of total billed charges,80% of total billed charges,132.94,37.27,,106.35,percent of total billed charges,37.27% of total billed charges,132.94,37.27,,106.35,percent of total billed charges,37.27% of total billed charges,132.94,37.27,,106.35,percent of total billed charges,37.27% 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,142.68,40,,114.14,percent of total billed charges,40% of total billed charges,132.94,285.36,
BUPIVACAINE/EPI .25%,6065130,CDM,636,RC,J0665,HCPCS,Outpatient,,,43.4,34.72,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.72,80,,27.78,percent of total billed charges,80% of total billed charges,16.18,37.27,,12.94,percent of total billed charges,37.27% of total billed charges,16.18,37.27,,12.94,percent of total billed charges,37.27% of total billed charges,16.18,37.27,,12.94,percent of total billed charges,37.27% of total billed charges,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.36,40,,13.89,percent of total billed charges,40% of total billed charges,0.01,34.72,
SCISSOR 5MM ETHICON,5801832,CDM,272,RC,,,Outpatient,,,292.5,234.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234,80,,187.2,percent of total billed charges,80% of total billed charges,109.01,37.27,,87.21,percent of total billed charges,37.27% of total billed charges,109.01,37.27,,87.21,percent of total billed charges,37.27% of total billed charges,109.01,37.27,,87.21,percent of total billed charges,37.27% 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,117,40,,93.6,percent of total billed charges,40% of total billed charges,109.01,234,
ARMOUR THYROID 1GR,6400014,CDM,250,RC,A9270,HCPCS,Outpatient,,,4.35,3.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.48,80,,2.78,percent of total billed charges,80% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% of total billed charges,1.62,37.27,,1.3,percent of total billed charges,37.27% 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,1.74,40,,1.39,percent of total billed charges,40% of total billed charges,1.62,3.48,
VANCOMYCIN 500MG ADV,6065130,CDM,636,RC,J3370,HCPCS,Outpatient,,,38.95,31.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.16,80,,24.93,percent of total billed charges,80% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% 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,15.58,40,,12.46,percent of total billed charges,40% of total billed charges,14.52,31.16,
NS 100ML ADV,6400014,CDM,250,RC,,,Outpatient,,,5,4.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4,80,,3.2,percent of total billed charges,80% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% of total billed charges,1.86,37.27,,1.49,percent of total billed charges,37.27% 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,2,40,,1.6,percent of total billed charges,40% of total billed charges,1.86,4,
LDH ISO ENZYMES,7012032,CDM,300,RC,,,Outpatient,,,52,41.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% 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,20.8,40,,16.64,percent of total billed charges,40% of total billed charges,19.38,41.6,
SUTURE SPIRAL PDO,5801832,CDM,272,RC,,,Outpatient,,,135.4,108.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.32,80,,86.66,percent of total billed charges,80% of total billed charges,50.46,37.27,,40.37,percent of total billed charges,37.27% of total billed charges,50.46,37.27,,40.37,percent of total billed charges,37.27% of total billed charges,50.46,37.27,,40.37,percent of total billed charges,37.27% 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,54.16,40,,43.33,percent of total billed charges,40% of total billed charges,50.46,108.32,
MORPHINE 2MG CJ,6065130,CDM,636,RC,J2270,HCPCS,Outpatient,,,13.1,10.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.48,80,,8.38,percent of total billed charges,80% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% of total billed charges,4.88,37.27,,3.9,percent of total billed charges,37.27% 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,5.24,40,,4.19,percent of total billed charges,40% of total billed charges,4.88,10.48,
PLACEMENT IO NEEDLE,8830002,CDM,450,RC,36680,HCPCS,Outpatient,,,726,580.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,580.8,80,,464.64,percent of total billed charges,80% of total billed charges,270.58,37.27,,216.46,percent of total billed charges,37.27% of total billed charges,270.58,37.27,,216.46,percent of total billed charges,37.27% of total billed charges,270.58,37.27,,216.46,percent of total billed charges,37.27% of total billed charges,328.51,100,,,fee schedule,100% of APC rate,328.51,100,,,fee schedule,100% of APC rate,328.51,100,,,fee schedule,100% of APC rate,84.85,145,,,fee schedule,145% of CMS fee schedule,328.51,100,,,fee schedule,100% of APC rate,328.51,100,,,fee schedule,100% of APC rate,328.51,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.4,40,,232.32,percent of total billed charges,40% of total billed charges,84.85,580.8,
CUROSURF 1.5ML,5880901,CDM,637,RC,,,Outpatient,,,1987,1589.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1589.6,80,,1271.68,percent of total billed charges,80% of total billed charges,740.55,37.27,,592.44,percent of total billed charges,37.27% of total billed charges,740.55,37.27,,592.44,percent of total billed charges,37.27% of total billed charges,740.55,37.27,,592.44,percent of total billed charges,37.27% 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,794.8,40,,635.84,percent of total billed charges,40% of total billed charges,740.55,1589.6,
AMINOSYN 8.5% 500ML,6400014,CDM,250,RC,,,Outpatient,,,199.8,159.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.84,80,,127.87,percent of total billed charges,80% of total billed charges,74.47,37.27,,59.58,percent of total billed charges,37.27% of total billed charges,74.47,37.27,,59.58,percent of total billed charges,37.27% of total billed charges,74.47,37.27,,59.58,percent of total billed charges,37.27% 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,79.92,40,,63.94,percent of total billed charges,40% of total billed charges,74.47,159.84,
ACETYLCYSTEINE 6GMIV,6400014,CDM,250,RC,,,Outpatient,,,679.05,543.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,543.24,80,,434.59,percent of total billed charges,80% of total billed charges,253.08,37.27,,202.46,percent of total billed charges,37.27% of total billed charges,253.08,37.27,,202.46,percent of total billed charges,37.27% of total billed charges,253.08,37.27,,202.46,percent of total billed charges,37.27% 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,271.62,40,,217.3,percent of total billed charges,40% of total billed charges,253.08,543.24,
SURGIDAC SUTURE 48CM,5801832,CDM,272,RC,,,Outpatient,,,533.8,427.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,427.04,80,,341.63,percent of total billed charges,80% of total billed charges,198.95,37.27,,159.16,percent of total billed charges,37.27% of total billed charges,198.95,37.27,,159.16,percent of total billed charges,37.27% of total billed charges,198.95,37.27,,159.16,percent of total billed charges,37.27% 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,213.52,40,,170.82,percent of total billed charges,40% of total billed charges,198.95,427.04,
PROT ELECTRO 24HR UA,7018237,CDM,307,RC,,,Outpatient,,,117,93.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.6,80,,74.88,percent of total billed charges,80% of total billed charges,43.61,37.27,,34.89,percent of total billed charges,37.27% of total billed charges,43.61,37.27,,34.89,percent of total billed charges,37.27% of total billed charges,43.61,37.27,,34.89,percent of total billed charges,37.27% 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,46.8,40,,37.44,percent of total billed charges,40% of total billed charges,43.61,93.6,
BLOOD PATCH,8400010,CDM,760,RC,62273,HCPCS,Outpatient,,,2921,2336.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2336.8,80,,1869.44,percent of total billed charges,80% of total billed charges,1088.66,37.27,,870.93,percent of total billed charges,37.27% of total billed charges,1088.66,37.27,,870.93,percent of total billed charges,37.27% of total billed charges,1088.66,37.27,,870.93,percent of total billed charges,37.27% of total billed charges,570.17,100,,,fee schedule,100% of APC rate,570.17,100,,,fee schedule,100% of APC rate,570.17,100,,,fee schedule,100% of APC rate,158.2,145,,,fee schedule,145% of CMS fee schedule,570.17,100,,,fee schedule,100% of APC rate,570.17,100,,,fee schedule,100% of APC rate,570.17,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1168.4,40,,934.72,percent of total billed charges,40% of total billed charges,158.2,2336.8,
LIDOCAINE 1% 20ML VL,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,13.85,11.08,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.08,80,,8.86,percent of total billed charges,80% of total billed charges,5.16,37.27,,4.13,percent of total billed charges,37.27% of total billed charges,5.16,37.27,,4.13,percent of total billed charges,37.27% of total billed charges,5.16,37.27,,4.13,percent of total billed charges,37.27% 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,5.54,40,,4.43,percent of total billed charges,40% of total billed charges,5.16,11.08,
LIDOCAINE 2% 50ML VL,6400014,CDM,250,RC,,,Outpatient,,,0.01,0.01,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,80,,0.01,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,0.01,0.01,
ANTIBODY TITER,7051695,CDM,390,RC,86886,HCPCS,Outpatient,,,258.36,206.69,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,206.69,80,,165.35,percent of total billed charges,80% of total billed charges,96.29,37.27,,77.03,percent of total billed charges,37.27% of total billed charges,96.29,37.27,,77.03,percent of total billed charges,37.27% of total billed charges,96.29,37.27,,77.03,percent of total billed charges,37.27% of total billed charges,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,5.18,100,,,fee schedule,100% of CMS fee schedule,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.34,40,,82.67,percent of total billed charges,40% of total billed charges,5.18,206.69,
TAPE MEDIPORE/HYPAFI,5801832,CDM,272,RC,,,Outpatient,,,26.8,21.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.44,80,,17.15,percent of total billed charges,80% of total billed charges,9.99,37.27,,7.99,percent of total billed charges,37.27% of total billed charges,9.99,37.27,,7.99,percent of total billed charges,37.27% of total billed charges,9.99,37.27,,7.99,percent of total billed charges,37.27% 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,10.72,40,,8.58,percent of total billed charges,40% of total billed charges,9.99,21.44,
OXYHOOD SMALL,5801832,CDM,272,RC,,,Outpatient,,,50.5,40.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.4,80,,32.32,percent of total billed charges,80% of total billed charges,18.82,37.27,,15.06,percent of total billed charges,37.27% of total billed charges,18.82,37.27,,15.06,percent of total billed charges,37.27% of total billed charges,18.82,37.27,,15.06,percent of total billed charges,37.27% 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,20.2,40,,16.16,percent of total billed charges,40% of total billed charges,18.82,40.4,
OXYHOOD MEDIUM,5801832,CDM,272,RC,,,Outpatient,,,50.5,40.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.4,80,,32.32,percent of total billed charges,80% of total billed charges,18.82,37.27,,15.06,percent of total billed charges,37.27% of total billed charges,18.82,37.27,,15.06,percent of total billed charges,37.27% of total billed charges,18.82,37.27,,15.06,percent of total billed charges,37.27% 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,20.2,40,,16.16,percent of total billed charges,40% of total billed charges,18.82,40.4,
OXYHOOD LARGE,5801832,CDM,272,RC,,,Outpatient,,,56.75,45.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.4,80,,36.32,percent of total billed charges,80% of total billed charges,21.15,37.27,,16.92,percent of total billed charges,37.27% of total billed charges,21.15,37.27,,16.92,percent of total billed charges,37.27% of total billed charges,21.15,37.27,,16.92,percent of total billed charges,37.27% 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,22.7,40,,18.16,percent of total billed charges,40% of total billed charges,21.15,45.4,
DOPPLER PROBE COVER,5801832,CDM,272,RC,,,Outpatient,,,50.8,40.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.64,80,,32.51,percent of total billed charges,80% of total billed charges,18.93,37.27,,15.14,percent of total billed charges,37.27% of total billed charges,18.93,37.27,,15.14,percent of total billed charges,37.27% of total billed charges,18.93,37.27,,15.14,percent of total billed charges,37.27% 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,20.32,40,,16.26,percent of total billed charges,40% of total billed charges,18.93,40.64,
CELL CNT SYNOVIAL FL,7000029,CDM,301,RC,,,Outpatient,,,222,177.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% 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,88.8,40,,71.04,percent of total billed charges,40% of total billed charges,82.74,177.6,
LEVETIRACETAM 500MG,6065130,CDM,636,RC,J1953,HCPCS,Outpatient,,,0.83,0.66,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.66,80,,0.53,percent of total billed charges,80% of total billed charges,0.31,37.27,,0.25,percent of total billed charges,37.27% of total billed charges,0.31,37.27,,0.25,percent of total billed charges,37.27% of total billed charges,0.31,37.27,,0.25,percent of total billed charges,37.27% 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,0.33,40,,0.26,percent of total billed charges,40% of total billed charges,0.31,0.66,
INSITU HYDRIDIZATION,7080054,CDM,312,RC,88365,HCPCS,Outpatient,,,335,268.00,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,268,80,,214.4,percent of total billed charges,80% of total billed charges,124.85,37.27,,99.88,percent of total billed charges,37.27% of total billed charges,124.85,37.27,,99.88,percent of total billed charges,37.27% of total billed charges,124.85,37.27,,99.88,percent of total billed charges,37.27% of total billed charges,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,172.77,145,,,fee schedule,145% of CMS fee schedule,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134,40,,107.2,percent of total billed charges,40% of total billed charges,124.85,268,
NDL HAWKINS BLN206X5,5801832,CDM,272,RC,,,Outpatient,,,170,136.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136,80,,108.8,percent of total billed charges,80% of total billed charges,63.36,37.27,,50.69,percent of total billed charges,37.27% of total billed charges,63.36,37.27,,50.69,percent of total billed charges,37.27% of total billed charges,63.36,37.27,,50.69,percent of total billed charges,37.27% 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,68,40,,54.4,percent of total billed charges,40% of total billed charges,63.36,136,
NDL HAWKINSBLN206X10,5801832,CDM,272,RC,,,Outpatient,,,170,136.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136,80,,108.8,percent of total billed charges,80% of total billed charges,63.36,37.27,,50.69,percent of total billed charges,37.27% of total billed charges,63.36,37.27,,50.69,percent of total billed charges,37.27% of total billed charges,63.36,37.27,,50.69,percent of total billed charges,37.27% 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,68,40,,54.4,percent of total billed charges,40% of total billed charges,63.36,136,
TRANSPEC SPEC CUP,5801832,CDM,272,RC,,,Outpatient,,,93.45,74.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.76,80,,59.81,percent of total billed charges,80% of total billed charges,34.83,37.27,,27.86,percent of total billed charges,37.27% of total billed charges,34.83,37.27,,27.86,percent of total billed charges,37.27% of total billed charges,34.83,37.27,,27.86,percent of total billed charges,37.27% 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,37.38,40,,29.9,percent of total billed charges,40% of total billed charges,34.83,74.76,
TRAY CT BIOPSY STER,5801832,CDM,272,RC,,,Outpatient,,,45.15,36.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.12,80,,28.9,percent of total billed charges,80% of total billed charges,16.83,37.27,,13.46,percent of total billed charges,37.27% of total billed charges,16.83,37.27,,13.46,percent of total billed charges,37.27% of total billed charges,16.83,37.27,,13.46,percent of total billed charges,37.27% 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,18.06,40,,14.45,percent of total billed charges,40% of total billed charges,16.83,36.12,
NUCYNTA 25MG,6400014,CDM,250,RC,,,Outpatient,,,0.01,0.01,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,80,,0.01,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,0.01,0.01,
MRA LOWER EXT WO & W,,,616,RC,C8914,HCPCS,Outpatient,,,3564,2851.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,317.08,2851.2,
MRA LOWER EXT WO,,,616,RC,C8913,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,202.03,2412.8,
MILRINONE 50MG/50ML,6065130,CDM,636,RC,J2260,HCPCS,Outpatient,,,163.7,130.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130.96,80,,104.77,percent of total billed charges,80% of total billed charges,61.01,37.27,,48.81,percent of total billed charges,37.27% of total billed charges,61.01,37.27,,48.81,percent of total billed charges,37.27% of total billed charges,61.01,37.27,,48.81,percent of total billed charges,37.27% 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,65.48,40,,52.38,percent of total billed charges,40% of total billed charges,61.01,130.96,
CEFAZOLIN 2GM PREMIX,5880901,CDM,637,RC,J0690,HCPCS,Outpatient,,,60.39,48.31,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.31,80,,38.65,percent of total billed charges,80% of total billed charges,22.51,37.27,,18.01,percent of total billed charges,37.27% of total billed charges,22.51,37.27,,18.01,percent of total billed charges,37.27% of total billed charges,22.51,37.27,,18.01,percent of total billed charges,37.27% 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,24.16,40,,19.33,percent of total billed charges,40% of total billed charges,22.51,48.31,
ULTRACLIP II RIB 10C,5801832,CDM,272,RC,,,Outpatient,,,378,302.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,302.4,80,,241.92,percent of total billed charges,80% of total billed charges,140.88,37.27,,112.7,percent of total billed charges,37.27% of total billed charges,140.88,37.27,,112.7,percent of total billed charges,37.27% of total billed charges,140.88,37.27,,112.7,percent of total billed charges,37.27% 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,151.2,40,,120.96,percent of total billed charges,40% of total billed charges,140.88,302.4,
TRUGUIDE 7.8 CM,5801832,CDM,272,RC,,,Outpatient,,,90,72.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% 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,36,40,,28.8,percent of total billed charges,40% of total billed charges,33.54,72,
MAXCORE 10 CM,5801832,CDM,272,RC,,,Outpatient,,,252,201.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,80,,161.28,percent of total billed charges,80% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% 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,100.8,40,,80.64,percent of total billed charges,40% of total billed charges,93.92,201.6,
OXYHOOD LG WIDENECK,5801832,CDM,272,RC,,,Outpatient,,,56.75,45.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.4,80,,36.32,percent of total billed charges,80% of total billed charges,21.15,37.27,,16.92,percent of total billed charges,37.27% of total billed charges,21.15,37.27,,16.92,percent of total billed charges,37.27% of total billed charges,21.15,37.27,,16.92,percent of total billed charges,37.27% 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,22.7,40,,18.16,percent of total billed charges,40% of total billed charges,21.15,45.4,
HCZT 12.5MG CAPSULE,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
BRINTELLIX 10MG,6400014,CDM,250,RC,,,Outpatient,,,66.75,53.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,53.4,80,,42.72,percent of total billed charges,80% of total billed charges,24.88,37.27,,19.9,percent of total billed charges,37.27% of total billed charges,24.88,37.27,,19.9,percent of total billed charges,37.27% of total billed charges,24.88,37.27,,19.9,percent of total billed charges,37.27% 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,26.7,40,,21.36,percent of total billed charges,40% of total billed charges,24.88,53.4,
INVOKANA 300MG,6400014,CDM,250,RC,,,Outpatient,,,77.75,62.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.2,80,,49.76,percent of total billed charges,80% of total billed charges,28.98,37.27,,23.18,percent of total billed charges,37.27% of total billed charges,28.98,37.27,,23.18,percent of total billed charges,37.27% of total billed charges,28.98,37.27,,23.18,percent of total billed charges,37.27% 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,31.1,40,,24.88,percent of total billed charges,40% of total billed charges,28.98,62.2,
LIVALO 4MG,6400014,CDM,250,RC,,,Outpatient,,,43.55,34.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.84,80,,27.87,percent of total billed charges,80% of total billed charges,16.23,37.27,,12.98,percent of total billed charges,37.27% of total billed charges,16.23,37.27,,12.98,percent of total billed charges,37.27% of total billed charges,16.23,37.27,,12.98,percent of total billed charges,37.27% 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,17.42,40,,13.94,percent of total billed charges,40% of total billed charges,16.23,34.84,
TUBING CALIB LAP BAN,5801832,CDM,272,RC,,,Outpatient,,,500,400.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,400,80,,320,percent of total billed charges,80% of total billed charges,186.35,37.27,,149.08,percent of total billed charges,37.27% of total billed charges,186.35,37.27,,149.08,percent of total billed charges,37.27% of total billed charges,186.35,37.27,,149.08,percent of total billed charges,37.27% 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,200,40,,160,percent of total billed charges,40% of total billed charges,186.35,400,
PORTAPPLIER LAP BAND,5801832,CDM,272,RC,,,Outpatient,,,600,480.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,480,80,,384,percent of total billed charges,80% of total billed charges,223.62,37.27,,178.9,percent of total billed charges,37.27% of total billed charges,223.62,37.27,,178.9,percent of total billed charges,37.27% of total billed charges,223.62,37.27,,178.9,percent of total billed charges,37.27% 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,240,40,,192,percent of total billed charges,40% of total billed charges,223.62,480,
HUMALOG 100UN/ML,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,118.65,94.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.92,80,,75.94,percent of total billed charges,80% of total billed charges,44.22,37.27,,35.38,percent of total billed charges,37.27% of total billed charges,44.22,37.27,,35.38,percent of total billed charges,37.27% of total billed charges,44.22,37.27,,35.38,percent of total billed charges,37.27% 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,47.46,40,,37.97,percent of total billed charges,40% of total billed charges,44.22,94.92,
NEEDLE SPINAL22X3.5,5801832,CDM,272,RC,,,Outpatient,,,37.6,30.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.08,80,,24.06,percent of total billed charges,80% of total billed charges,14.01,37.27,,11.21,percent of total billed charges,37.27% of total billed charges,14.01,37.27,,11.21,percent of total billed charges,37.27% of total billed charges,14.01,37.27,,11.21,percent of total billed charges,37.27% 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,15.04,40,,12.03,percent of total billed charges,40% of total billed charges,14.01,30.08,
COVER TRANSDUCER CIV,5801832,CDM,272,RC,,,Outpatient,,,37.5,30.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,80,,24,percent of total billed charges,80% of total billed charges,13.98,37.27,,11.18,percent of total billed charges,37.27% of total billed charges,13.98,37.27,,11.18,percent of total billed charges,37.27% of total billed charges,13.98,37.27,,11.18,percent of total billed charges,37.27% 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,15,40,,12,percent of total billed charges,40% of total billed charges,13.98,30,
WEST NILE VIR AB CSF,7000169,CDM,302,RC,,,Outpatient,,,90,72.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72,80,,57.6,percent of total billed charges,80% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% of total billed charges,33.54,37.27,,26.83,percent of total billed charges,37.27% 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,36,40,,28.8,percent of total billed charges,40% of total billed charges,33.54,72,
VERAPAMIL 120MG TAB,6400014,CDM,250,RC,,,Outpatient,,,2.55,2.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.04,80,,1.63,percent of total billed charges,80% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% of total billed charges,0.95,37.27,,0.76,percent of total billed charges,37.27% 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,1.02,40,,0.82,percent of total billed charges,40% of total billed charges,0.95,2.04,
MULTI-TRACE 5,6400014,CDM,250,RC,,,Outpatient,,,532.8,426.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,426.24,80,,340.99,percent of total billed charges,80% of total billed charges,198.57,37.27,,158.86,percent of total billed charges,37.27% of total billed charges,198.57,37.27,,158.86,percent of total billed charges,37.27% of total billed charges,198.57,37.27,,158.86,percent of total billed charges,37.27% 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,213.12,40,,170.5,percent of total billed charges,40% of total billed charges,198.57,426.24,
E-Z GAS EFFERVESCENT,6400014,CDM,250,RC,,,Outpatient,,,11,8.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8.8,80,,7.04,percent of total billed charges,80% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% of total billed charges,4.1,37.27,,3.28,percent of total billed charges,37.27% 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,4.4,40,,3.52,percent of total billed charges,40% of total billed charges,4.1,8.8,
TROCAR 15X150 COR39,5801832,CDM,272,RC,,,Outpatient,,,315,252.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252,80,,201.6,percent of total billed charges,80% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% 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,126,40,,100.8,percent of total billed charges,40% of total billed charges,117.4,252,
MEDIHONEY,5880901,CDM,637,RC,,,Outpatient,,,79.5,63.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,80,,50.88,percent of total billed charges,80% of total billed charges,29.63,37.27,,23.7,percent of total billed charges,37.27% of total billed charges,29.63,37.27,,23.7,percent of total billed charges,37.27% of total billed charges,29.63,37.27,,23.7,percent of total billed charges,37.27% 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,31.8,40,,25.44,percent of total billed charges,40% of total billed charges,29.63,63.6,
LIBRIUM CARB 150MG,5880901,CDM,637,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
FLUZONE FLU VAC,6065130,CDM,636,RC,90686,HCPCS,Outpatient,,,58.51,46.81,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.81,80,,37.45,percent of total billed charges,80% of total billed charges,21.81,37.27,,17.45,percent of total billed charges,37.27% of total billed charges,21.81,37.27,,17.45,percent of total billed charges,37.27% of total billed charges,21.81,37.27,,17.45,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.52,100,,,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,23.4,40,,18.72,percent of total billed charges,40% of total billed charges,21.52,46.81,
PRILOSEC 20MG OTC,6400014,CDM,250,RC,,,Outpatient,,,2.95,2.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,80,,1.89,percent of total billed charges,80% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% 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,1.18,40,,0.94,percent of total billed charges,40% of total billed charges,1.1,2.36,
"PCA TUBING 90"" W/FIL",5801832,CDM,272,RC,,,Outpatient,,,39.75,31.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.8,80,,25.44,percent of total billed charges,80% of total billed charges,14.81,37.27,,11.85,percent of total billed charges,37.27% of total billed charges,14.81,37.27,,11.85,percent of total billed charges,37.27% of total billed charges,14.81,37.27,,11.85,percent of total billed charges,37.27% 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,15.9,40,,12.72,percent of total billed charges,40% of total billed charges,14.81,31.8,
"PCA TUBING 112"" EPID",5801832,CDM,272,RC,,,Outpatient,,,42.3,33.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.84,80,,27.07,percent of total billed charges,80% of total billed charges,15.77,37.27,,12.62,percent of total billed charges,37.27% of total billed charges,15.77,37.27,,12.62,percent of total billed charges,37.27% of total billed charges,15.77,37.27,,12.62,percent of total billed charges,37.27% 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,16.92,40,,13.54,percent of total billed charges,40% of total billed charges,15.77,33.84,
IV PUSH INITIAL,5811182,CDM,260,RC,96374,HCPCS,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,47.84,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198,40,,158.4,percent of total billed charges,40% of total billed charges,47.84,396,
IV PUSH EA ADDL NEW,5811182,CDM,260,RC,96375,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,20.17,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,40,,35.2,percent of total billed charges,40% of total billed charges,20.17,88,
IV PUSH EA ADDL SAME,5811182,CDM,260,RC,96376,HCPCS,Outpatient,,,108,86.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,86.4,80,,69.12,percent of total billed charges,80% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% of total billed charges,40.25,37.27,,32.2,percent of total billed charges,37.27% 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,43.2,40,,34.56,percent of total billed charges,40% of total billed charges,40.25,86.4,
INJECTION SUBC OR IM,5811182,CDM,260,RC,96372,HCPCS,Outpatient,,,77,61.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,19.31,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,19.31,61.6,
IV HYDRATION INITIAL,5811182,CDM,260,RC,96360,HCPCS,Outpatient,,,222,177.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,42.15,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,40,,71.04,percent of total billed charges,40% of total billed charges,42.15,177.6,
IV HYDRATION EA ADDL,5811182,CDM,260,RC,96361,HCPCS,Outpatient,,,77,61.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.6,80,,49.28,percent of total billed charges,80% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,28.7,37.27,,22.96,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,16.3,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.8,40,,24.64,percent of total billed charges,40% of total billed charges,16.3,61.6,
IV INFUSION INITIAL,5811182,CDM,260,RC,96365,HCPCS,Outpatient,,,526,420.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.8,80,,336.64,percent of total billed charges,80% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,81.26,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,40,,168.32,percent of total billed charges,40% of total billed charges,81.26,420.8,
IV INFUSION EA ADDL,5811182,CDM,260,RC,96366,HCPCS,Outpatient,,,123,98.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,26.98,145,,,fee schedule,145% of CMS fee schedule,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,39.15,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.2,40,,39.36,percent of total billed charges,40% of total billed charges,26.98,98.4,
NURSERY BEDSIDE PROC,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,554,443.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% 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,221.6,40,,177.28,percent of total billed charges,40% of total billed charges,206.48,443.2,
CONTINOUS PULSE OXIM,7441215,CDM,460,RC,94762,HCPCS,Outpatient,,,256,204.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.8,80,,163.84,percent of total billed charges,80% of total billed charges,95.41,37.27,,76.33,percent of total billed charges,37.27% of total billed charges,95.41,37.27,,76.33,percent of total billed charges,37.27% of total billed charges,95.41,37.27,,76.33,percent of total billed charges,37.27% of total billed charges,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,32.26,145,,,fee schedule,145% of CMS fee schedule,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.4,40,,81.92,percent of total billed charges,40% of total billed charges,32.26,204.8,
RIFABUTIN 150MG CAP,6400014,CDM,250,RC,,,Outpatient,,,59.65,47.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,47.72,80,,38.18,percent of total billed charges,80% of total billed charges,22.23,37.27,,17.78,percent of total billed charges,37.27% of total billed charges,22.23,37.27,,17.78,percent of total billed charges,37.27% of total billed charges,22.23,37.27,,17.78,percent of total billed charges,37.27% 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,23.86,40,,19.09,percent of total billed charges,40% of total billed charges,22.23,47.72,
BLADE PED RADENOID 4,5801832,CDM,272,RC,,,Outpatient,,,532.2,425.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.76,80,,340.61,percent of total billed charges,80% of total billed charges,198.35,37.27,,158.68,percent of total billed charges,37.27% of total billed charges,198.35,37.27,,158.68,percent of total billed charges,37.27% of total billed charges,198.35,37.27,,158.68,percent of total billed charges,37.27% 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,212.88,40,,170.3,percent of total billed charges,40% of total billed charges,198.35,425.76,
"BLADE 1"" CONMED",5801832,CDM,272,RC,,,Outpatient,,,29.2,23.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.36,80,,18.69,percent of total billed charges,80% of total billed charges,10.88,37.27,,8.7,percent of total billed charges,37.27% of total billed charges,10.88,37.27,,8.7,percent of total billed charges,37.27% of total billed charges,10.88,37.27,,8.7,percent of total billed charges,37.27% 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,11.68,40,,9.34,percent of total billed charges,40% of total billed charges,10.88,23.36,
COMPUTER ASSIS TECHN,7000268,CDM,310,RC,88361,HCPCS,Outpatient,,,430.86,344.69,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,344.69,80,,275.75,percent of total billed charges,80% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,160.58,37.27,,128.46,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,98.22,145,,,fee schedule,145% of CMS fee schedule,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,172.34,40,,137.87,percent of total billed charges,40% of total billed charges,98.22,344.69,
TUBE VNT DONALD CFLE,5801832,CDM,272,RC,,,Outpatient,,,72,57.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.6,80,,46.08,percent of total billed charges,80% of total billed charges,26.83,37.27,,21.46,percent of total billed charges,37.27% of total billed charges,26.83,37.27,,21.46,percent of total billed charges,37.27% of total billed charges,26.83,37.27,,21.46,percent of total billed charges,37.27% 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,28.8,40,,23.04,percent of total billed charges,40% of total billed charges,26.83,57.6,
CTA CHEST FOR PE,6010052,CDM,350,RC,71275,HCPCS,Outpatient,,,2124,1699.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1699.2,80,,1359.36,percent of total billed charges,80% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,258.72,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,849.6,40,,679.68,percent of total billed charges,40% of total billed charges,151.49,1699.2,
CAR SEAT TEST 60 MIN,7439094,CDM,410,RC,94780,HCPCS,Outpatient,,,333,266.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,266.4,80,,213.12,percent of total billed charges,80% of total billed charges,124.11,37.27,,99.29,percent of total billed charges,37.27% of total billed charges,124.11,37.27,,99.29,percent of total billed charges,37.27% of total billed charges,124.11,37.27,,99.29,percent of total billed charges,37.27% of total billed charges,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,32.42,145,,,fee schedule,145% of CMS fee schedule,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.2,40,,106.56,percent of total billed charges,40% of total billed charges,32.42,266.4,
CARSEAT TEST ADD 30,7439094,CDM,410,RC,94781,HCPCS,Outpatient,,,333,266.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,266.4,80,,213.12,percent of total billed charges,80% of total billed charges,124.11,37.27,,99.29,percent of total billed charges,37.27% of total billed charges,124.11,37.27,,99.29,percent of total billed charges,37.27% of total billed charges,124.11,37.27,,99.29,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.28,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,133.2,40,,106.56,percent of total billed charges,40% of total billed charges,11.28,266.4,
DIABETES AUTOIMMUNE,7000029,CDM,301,RC,,,Outpatient,,,492,393.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,393.6,80,,314.88,percent of total billed charges,80% of total billed charges,183.37,37.27,,146.7,percent of total billed charges,37.27% of total billed charges,183.37,37.27,,146.7,percent of total billed charges,37.27% of total billed charges,183.37,37.27,,146.7,percent of total billed charges,37.27% 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,196.8,40,,157.44,percent of total billed charges,40% of total billed charges,183.37,393.6,
TUBING STRAIGHT IRR,5801832,CDM,272,RC,,,Outpatient,,,153,122.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,122.4,80,,97.92,percent of total billed charges,80% of total billed charges,57.02,37.27,,45.62,percent of total billed charges,37.27% of total billed charges,57.02,37.27,,45.62,percent of total billed charges,37.27% of total billed charges,57.02,37.27,,45.62,percent of total billed charges,37.27% 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,61.2,40,,48.96,percent of total billed charges,40% of total billed charges,57.02,122.4,
VAC ADMIN EACH ADDL,9397936,CDM,771,RC,90472,HCPCS,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.62,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,19.62,58.4,
VAC ADMIN 1ST (HEP B,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,160,128.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,27.36,128,
VAC ADMIN EA ADDL,9397936,CDM,771,RC,90472,HCPCS,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.62,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,19.62,58.4,
CYTOPATH EVAL FHA RE,7039034,CDM,311,RC,88173,HCPCS,Outpatient,,,218,174.40,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,174.4,80,,139.52,percent of total billed charges,80% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% of total billed charges,81.25,37.27,,65,percent of total billed charges,37.27% of total billed charges,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,127.22,145,,,fee schedule,145% of CMS fee schedule,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,44.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.2,40,,69.76,percent of total billed charges,40% of total billed charges,44.67,174.4,
SLOW-MAG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CALCITRATE TAB,5880901,CDM,637,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
WELCHOL 3.75GM PKT,6400014,CDM,250,RC,,,Outpatient,,,85.2,68.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.16,80,,54.53,percent of total billed charges,80% of total billed charges,31.75,37.27,,25.4,percent of total billed charges,37.27% of total billed charges,31.75,37.27,,25.4,percent of total billed charges,37.27% of total billed charges,31.75,37.27,,25.4,percent of total billed charges,37.27% 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,34.08,40,,27.26,percent of total billed charges,40% of total billed charges,31.75,68.16,
TAMOXIFEN 20MG TAB,6400014,CDM,250,RC,,,Outpatient,,,12.9,10.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.32,80,,8.26,percent of total billed charges,80% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% 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,5.16,40,,4.13,percent of total billed charges,40% of total billed charges,4.81,10.32,
ANTI-IGE RECPTOR AB,7000169,CDM,302,RC,,,Outpatient,,,648.86,519.09,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,519.09,80,,415.27,percent of total billed charges,80% of total billed charges,241.83,37.27,,193.46,percent of total billed charges,37.27% of total billed charges,241.83,37.27,,193.46,percent of total billed charges,37.27% of total billed charges,241.83,37.27,,193.46,percent of total billed charges,37.27% 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,259.54,40,,207.63,percent of total billed charges,40% of total billed charges,241.83,519.09,
EPI DISC T M,5801832,CDM,272,RC,,,Outpatient,,,474,379.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,379.2,80,,303.36,percent of total billed charges,80% of total billed charges,176.66,37.27,,141.33,percent of total billed charges,37.27% of total billed charges,176.66,37.27,,141.33,percent of total billed charges,37.27% of total billed charges,176.66,37.27,,141.33,percent of total billed charges,37.27% 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,189.6,40,,151.68,percent of total billed charges,40% of total billed charges,176.66,379.2,
FLOSEAL HEMOSTATIC,6400014,CDM,250,RC,,,Outpatient,,,1231.7,985.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,985.36,80,,788.29,percent of total billed charges,80% of total billed charges,459.05,37.27,,367.24,percent of total billed charges,37.27% of total billed charges,459.05,37.27,,367.24,percent of total billed charges,37.27% of total billed charges,459.05,37.27,,367.24,percent of total billed charges,37.27% 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,492.68,40,,394.14,percent of total billed charges,40% of total billed charges,459.05,985.36,
OXYCOCONE/APAP 7.5,6400014,CDM,250,RC,,,Outpatient,,,9.55,7.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.64,80,,6.11,percent of total billed charges,80% of total billed charges,3.56,37.27,,2.85,percent of total billed charges,37.27% of total billed charges,3.56,37.27,,2.85,percent of total billed charges,37.27% of total billed charges,3.56,37.27,,2.85,percent of total billed charges,37.27% 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,3.82,40,,3.06,percent of total billed charges,40% of total billed charges,3.56,7.64,
VAPOTHERM CARTRIDGE,5801832,CDM,272,RC,,,Outpatient,,,425,340.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,340,80,,272,percent of total billed charges,80% of total billed charges,158.4,37.27,,126.72,percent of total billed charges,37.27% of total billed charges,158.4,37.27,,126.72,percent of total billed charges,37.27% of total billed charges,158.4,37.27,,126.72,percent of total billed charges,37.27% 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,170,40,,136,percent of total billed charges,40% of total billed charges,158.4,340,
DRAPE MAGNETIC 16X20,5801832,CDM,272,RC,,,Outpatient,,,34.05,27.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.24,80,,21.79,percent of total billed charges,80% of total billed charges,12.69,37.27,,10.15,percent of total billed charges,37.27% of total billed charges,12.69,37.27,,10.15,percent of total billed charges,37.27% of total billed charges,12.69,37.27,,10.15,percent of total billed charges,37.27% 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,13.62,40,,10.9,percent of total billed charges,40% of total billed charges,12.69,27.24,
US BREAST LIMITED UN,6000566,CDM,402,RC,76642,HCPCS,Outpatient,,,428,342.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,342.4,80,,273.92,percent of total billed charges,80% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,67.35,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.2,40,,136.96,percent of total billed charges,40% of total billed charges,67.35,342.4,
US BREAST COMPLETE,6000566,CDM,402,RC,76641,HCPCS,Outpatient,,,428,342.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,342.4,80,,273.92,percent of total billed charges,80% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,86.8,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.2,40,,136.96,percent of total billed charges,40% of total billed charges,86.8,342.4,
THAW RARE REAGENT RE,7000169,CDM,302,RC,86970,HCPCS,Outpatient,,,63,50.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.4,80,,40.32,percent of total billed charges,80% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,23.48,37.27,,18.78,percent of total billed charges,37.27% of total billed charges,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,25.2,40,,20.16,percent of total billed charges,40% of total billed charges,23.48,50.43,
ADENOSINE 6MG INJ,6065130,CDM,636,RC,J0153,HCPCS,Outpatient,,,24.77,19.82,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.82,80,,15.86,percent of total billed charges,80% of total billed charges,9.23,37.27,,7.38,percent of total billed charges,37.27% of total billed charges,9.23,37.27,,7.38,percent of total billed charges,37.27% of total billed charges,9.23,37.27,,7.38,percent of total billed charges,37.27% 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,9.91,40,,7.93,percent of total billed charges,40% of total billed charges,9.23,19.82,
CONT INHAL TRMT 1ST,7439094,CDM,410,RC,94644,HCPCS,Outpatient,,,191,152.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,152.8,80,,122.24,percent of total billed charges,80% of total billed charges,71.19,37.27,,56.95,percent of total billed charges,37.27% of total billed charges,71.19,37.27,,56.95,percent of total billed charges,37.27% of total billed charges,71.19,37.27,,56.95,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,75.94,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.4,40,,61.12,percent of total billed charges,40% of total billed charges,71.19,152.8,
TUBING POWERPUMP LT,5801832,CDM,272,RC,,,Outpatient,,,272.7,218.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,218.16,80,,174.53,percent of total billed charges,80% of total billed charges,101.64,37.27,,81.31,percent of total billed charges,37.27% of total billed charges,101.64,37.27,,81.31,percent of total billed charges,37.27% of total billed charges,101.64,37.27,,81.31,percent of total billed charges,37.27% 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,109.08,40,,87.26,percent of total billed charges,40% of total billed charges,101.64,218.16,
LINEZOLID 600MG IV,6065130,CDM,636,RC,J2020,HCPCS,Outpatient,,,83.3,66.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.64,80,,53.31,percent of total billed charges,80% of total billed charges,31.05,37.27,,24.84,percent of total billed charges,37.27% of total billed charges,31.05,37.27,,24.84,percent of total billed charges,37.27% of total billed charges,31.05,37.27,,24.84,percent of total billed charges,37.27% 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,33.32,40,,26.66,percent of total billed charges,40% of total billed charges,31.05,66.64,
TUMOR IMMUNOHISTOCHE,7080072,CDM,314,RC,88361,HCPCS,Outpatient,,,293,234.40,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.4,80,,187.52,percent of total billed charges,80% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,98.22,145,,,fee schedule,145% of CMS fee schedule,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,117.2,40,,93.76,percent of total billed charges,40% of total billed charges,98.22,296.36,
EA MULTI PROBE STAIN,7080072,CDM,314,RC,88377,HCPCS,Outpatient,,,461,368.80,TC,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368.8,80,,295.04,percent of total billed charges,80% of total billed charges,171.81,37.27,,137.45,percent of total billed charges,37.27% of total billed charges,171.81,37.27,,137.45,percent of total billed charges,37.27% of total billed charges,171.81,37.27,,137.45,percent of total billed charges,37.27% of total billed charges,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,423.62,145,,,fee schedule,145% of CMS fee schedule,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,140.82,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.4,40,,147.52,percent of total billed charges,40% of total billed charges,140.82,423.62,
US SPINAL CANAL,6000566,CDM,402,RC,76800,HCPCS,Outpatient,,,348,278.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,141.77,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,139.2,40,,111.36,percent of total billed charges,40% of total billed charges,90.64,278.4,
US INFANT HIPS,6000566,CDM,402,RC,76885,HCPCS,Outpatient,,,226,180.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180.8,80,,144.64,percent of total billed charges,80% of total billed charges,84.23,37.27,,67.38,percent of total billed charges,37.27% of total billed charges,84.23,37.27,,67.38,percent of total billed charges,37.27% of total billed charges,84.23,37.27,,67.38,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,128.37,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,90.4,40,,72.32,percent of total billed charges,40% of total billed charges,74.92,180.8,
3D RENDERING,6010052,CDM,350,RC,76376,HCPCS,Outpatient,,,159,127.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.2,80,,101.76,percent of total billed charges,80% of total billed charges,59.26,37.27,,47.41,percent of total billed charges,37.27% of total billed charges,59.26,37.27,,47.41,percent of total billed charges,37.27% of total billed charges,59.26,37.27,,47.41,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,40,,50.88,percent of total billed charges,40% of total billed charges,20,127.2,
3D RENDERING,6212047,CDM,610,RC,76376,HCPCS,Outpatient,,,159,127.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,127.2,80,,101.76,percent of total billed charges,80% of total billed charges,59.26,37.27,,47.41,percent of total billed charges,37.27% of total billed charges,59.26,37.27,,47.41,percent of total billed charges,37.27% of total billed charges,59.26,37.27,,47.41,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.6,40,,50.88,percent of total billed charges,40% of total billed charges,20,127.2,
RAPID RHINO 900 EPIS,5801832,CDM,272,RC,,,Outpatient,,,305.55,244.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.44,80,,195.55,percent of total billed charges,80% of total billed charges,113.88,37.27,,91.1,percent of total billed charges,37.27% of total billed charges,113.88,37.27,,91.1,percent of total billed charges,37.27% of total billed charges,113.88,37.27,,91.1,percent of total billed charges,37.27% 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,122.22,40,,97.78,percent of total billed charges,40% of total billed charges,113.88,244.44,
PHENAZOPYRIDINE 97.5,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
MEROGEL NASAL DRESSI,5801832,CDM,272,RC,,,Outpatient,,,409.5,327.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,327.6,80,,262.08,percent of total billed charges,80% of total billed charges,152.62,37.27,,122.1,percent of total billed charges,37.27% of total billed charges,152.62,37.27,,122.1,percent of total billed charges,37.27% of total billed charges,152.62,37.27,,122.1,percent of total billed charges,37.27% 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,163.8,40,,131.04,percent of total billed charges,40% of total billed charges,152.62,327.6,
INFER TURB BLADE 2MM,5801832,CDM,272,RC,,,Outpatient,,,691.35,553.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,553.08,80,,442.46,percent of total billed charges,80% of total billed charges,257.67,37.27,,206.14,percent of total billed charges,37.27% of total billed charges,257.67,37.27,,206.14,percent of total billed charges,37.27% of total billed charges,257.67,37.27,,206.14,percent of total billed charges,37.27% 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,276.54,40,,221.23,percent of total billed charges,40% of total billed charges,257.67,553.08,
ENDOSCRUB 2LENS CLEA,5801832,CDM,272,RC,,,Outpatient,,,280.8,224.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224.64,80,,179.71,percent of total billed charges,80% of total billed charges,104.65,37.27,,83.72,percent of total billed charges,37.27% of total billed charges,104.65,37.27,,83.72,percent of total billed charges,37.27% of total billed charges,104.65,37.27,,83.72,percent of total billed charges,37.27% 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,112.32,40,,89.86,percent of total billed charges,40% of total billed charges,104.65,224.64,
ULTRA PRO II KIT,5801832,CDM,272,RC,,,Outpatient,,,82.3,65.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.84,80,,52.67,percent of total billed charges,80% of total billed charges,30.67,37.27,,24.54,percent of total billed charges,37.27% of total billed charges,30.67,37.27,,24.54,percent of total billed charges,37.27% of total billed charges,30.67,37.27,,24.54,percent of total billed charges,37.27% 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,32.92,40,,26.34,percent of total billed charges,40% of total billed charges,30.67,65.84,
REUTER SPLINT LG,5801832,CDM,272,RC,,,Outpatient,,,91.2,72.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.96,80,,58.37,percent of total billed charges,80% of total billed charges,33.99,37.27,,27.19,percent of total billed charges,37.27% of total billed charges,33.99,37.27,,27.19,percent of total billed charges,37.27% of total billed charges,33.99,37.27,,27.19,percent of total billed charges,37.27% 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,36.48,40,,29.18,percent of total billed charges,40% of total billed charges,33.99,72.96,
THERMASPLINT SM,5801832,CDM,272,RC,,,Outpatient,,,69.6,55.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,80,,44.54,percent of total billed charges,80% of total billed charges,25.94,37.27,,20.75,percent of total billed charges,37.27% of total billed charges,25.94,37.27,,20.75,percent of total billed charges,37.27% of total billed charges,25.94,37.27,,20.75,percent of total billed charges,37.27% 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,27.84,40,,22.27,percent of total billed charges,40% of total billed charges,25.94,55.68,
THERMASPLINT MED,5801832,CDM,272,RC,,,Outpatient,,,71.4,57.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.12,80,,45.7,percent of total billed charges,80% of total billed charges,26.61,37.27,,21.29,percent of total billed charges,37.27% of total billed charges,26.61,37.27,,21.29,percent of total billed charges,37.27% of total billed charges,26.61,37.27,,21.29,percent of total billed charges,37.27% 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,28.56,40,,22.85,percent of total billed charges,40% of total billed charges,26.61,57.12,
MEROCEL SINUS PACK,5801832,CDM,272,RC,,,Outpatient,,,53.4,42.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.72,80,,34.18,percent of total billed charges,80% of total billed charges,19.9,37.27,,15.92,percent of total billed charges,37.27% of total billed charges,19.9,37.27,,15.92,percent of total billed charges,37.27% of total billed charges,19.9,37.27,,15.92,percent of total billed charges,37.27% 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,21.36,40,,17.09,percent of total billed charges,40% of total billed charges,19.9,42.72,
THERMASPLINT LG,5801832,CDM,272,RC,,,Outpatient,,,69.6,55.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.68,80,,44.54,percent of total billed charges,80% of total billed charges,25.94,37.27,,20.75,percent of total billed charges,37.27% of total billed charges,25.94,37.27,,20.75,percent of total billed charges,37.27% of total billed charges,25.94,37.27,,20.75,percent of total billed charges,37.27% 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,27.84,40,,22.27,percent of total billed charges,40% of total billed charges,25.94,55.68,
RAMIPRIL 1.25MG CAP,6400014,CDM,250,RC,,,Outpatient,,,5.2,4.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.16,80,,3.33,percent of total billed charges,80% of total billed charges,1.94,37.27,,1.55,percent of total billed charges,37.27% of total billed charges,1.94,37.27,,1.55,percent of total billed charges,37.27% of total billed charges,1.94,37.27,,1.55,percent of total billed charges,37.27% 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,2.08,40,,1.66,percent of total billed charges,40% of total billed charges,1.94,4.16,
EXELON 13.3MG PATCH,6400014,CDM,250,RC,,,Outpatient,,,85.35,68.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.28,80,,54.62,percent of total billed charges,80% of total billed charges,31.81,37.27,,25.45,percent of total billed charges,37.27% of total billed charges,31.81,37.27,,25.45,percent of total billed charges,37.27% of total billed charges,31.81,37.27,,25.45,percent of total billed charges,37.27% 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,34.14,40,,27.31,percent of total billed charges,40% of total billed charges,31.81,68.28,
TOXOPLASMA IGG & IGM,7000169,CDM,302,RC,,,Outpatient,,,182,145.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% 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,72.8,40,,58.24,percent of total billed charges,40% of total billed charges,67.83,145.6,
ZEISS MICROSCOPE DRA,5801832,CDM,272,RC,,,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% 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,28,40,,22.4,percent of total billed charges,40% of total billed charges,26.09,56,
LEVETIRACETAM ER 500,6400014,CDM,250,RC,,,Outpatient,,,15.15,12.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.12,80,,9.7,percent of total billed charges,80% of total billed charges,5.65,37.27,,4.52,percent of total billed charges,37.27% of total billed charges,5.65,37.27,,4.52,percent of total billed charges,37.27% of total billed charges,5.65,37.27,,4.52,percent of total billed charges,37.27% 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,6.06,40,,4.85,percent of total billed charges,40% of total billed charges,5.65,12.12,
PROT C DEFICIENCY PR,7000169,CDM,302,RC,,,Outpatient,,,414,331.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,331.2,80,,264.96,percent of total billed charges,80% of total billed charges,154.3,37.27,,123.44,percent of total billed charges,37.27% of total billed charges,154.3,37.27,,123.44,percent of total billed charges,37.27% of total billed charges,154.3,37.27,,123.44,percent of total billed charges,37.27% 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,165.6,40,,132.48,percent of total billed charges,40% of total billed charges,154.3,331.2,
CT/GC EYE NAA,7069243,CDM,309,RC,,,Outpatient,,,206.48,165.18,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,165.18,80,,132.14,percent of total billed charges,80% of total billed charges,76.96,37.27,,61.57,percent of total billed charges,37.27% of total billed charges,76.96,37.27,,61.57,percent of total billed charges,37.27% of total billed charges,76.96,37.27,,61.57,percent of total billed charges,37.27% 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,82.59,40,,66.07,percent of total billed charges,40% of total billed charges,76.96,165.18,
INVOKANA 100MG TAB,5880901,CDM,637,RC,,,Outpatient,,,81.65,65.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.32,80,,52.26,percent of total billed charges,80% of total billed charges,30.43,37.27,,24.34,percent of total billed charges,37.27% of total billed charges,30.43,37.27,,24.34,percent of total billed charges,37.27% of total billed charges,30.43,37.27,,24.34,percent of total billed charges,37.27% 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,32.66,40,,26.13,percent of total billed charges,40% of total billed charges,30.43,65.32,
PROTOPAM 1000MG INJ,6065130,CDM,636,RC,J2730,HCPCS,Outpatient,,,354.75,283.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,283.8,80,,227.04,percent of total billed charges,80% of total billed charges,132.22,37.27,,105.78,percent of total billed charges,37.27% of total billed charges,132.22,37.27,,105.78,percent of total billed charges,37.27% of total billed charges,132.22,37.27,,105.78,percent of total billed charges,37.27% 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,141.9,40,,113.52,percent of total billed charges,40% of total billed charges,132.22,283.8,
I-131 ISOTOPE,6071625,CDM,343,RC,A9517,HCPCS,Outpatient,,,157,125.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.6,80,,100.48,percent of total billed charges,80% of total billed charges,58.51,37.27,,46.81,percent of total billed charges,37.27% of total billed charges,58.51,37.27,,46.81,percent of total billed charges,37.27% of total billed charges,58.51,37.27,,46.81,percent of total billed charges,37.27% of total billed charges,21.34,100,,,fee schedule,100% of APC rate,21.34,100,,,fee schedule,100% of APC rate,21.34,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,21.34,100,,,fee schedule,100% of APC rate,21.34,100,,,fee schedule,100% of APC rate,21.34,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.8,40,,50.24,percent of total billed charges,40% of total billed charges,21.34,125.6,
PEPPERMINT OIL 3.7ML,6400014,CDM,250,RC,,,Outpatient,,,72.45,57.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.96,80,,46.37,percent of total billed charges,80% of total billed charges,27,37.27,,21.6,percent of total billed charges,37.27% of total billed charges,27,37.27,,21.6,percent of total billed charges,37.27% of total billed charges,27,37.27,,21.6,percent of total billed charges,37.27% 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,28.98,40,,23.18,percent of total billed charges,40% of total billed charges,27,57.96,
FENOFIBRATE 134MG,5880901,CDM,637,RC,,,Outpatient,,,6.65,5.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.32,80,,4.26,percent of total billed charges,80% of total billed charges,2.48,37.27,,1.98,percent of total billed charges,37.27% of total billed charges,2.48,37.27,,1.98,percent of total billed charges,37.27% of total billed charges,2.48,37.27,,1.98,percent of total billed charges,37.27% 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,2.66,40,,2.13,percent of total billed charges,40% of total billed charges,2.48,5.32,
GLUCERNA SHAKE CHOCO,5880901,CDM,637,RC,,,Outpatient,,,7.6,6.08,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.08,80,,4.86,percent of total billed charges,80% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% of total billed charges,2.83,37.27,,2.26,percent of total billed charges,37.27% 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,3.04,40,,2.43,percent of total billed charges,40% of total billed charges,2.83,6.08,
DALVANCE 500MGPER5MG,6065130,CDM,636,RC,J0875,HCPCS,Outpatient,,,72.8,58.24,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.24,80,,46.59,percent of total billed charges,80% of total billed charges,27.13,37.27,,21.7,percent of total billed charges,37.27% of total billed charges,27.13,37.27,,21.7,percent of total billed charges,37.27% of total billed charges,27.13,37.27,,21.7,percent of total billed charges,37.27% of total billed charges,15.61,100,,,fee schedule,100% of APC rate,15.61,100,,,fee schedule,100% of APC rate,15.61,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,15.61,100,,,fee schedule,100% of APC rate,15.61,100,,,fee schedule,100% of APC rate,15.61,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.12,40,,23.3,percent of total billed charges,40% of total billed charges,15.61,58.24,
NAMENDA XR 28MG,6400014,CDM,250,RC,,,Outpatient,,,63.4,50.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.72,80,,40.58,percent of total billed charges,80% of total billed charges,23.63,37.27,,18.9,percent of total billed charges,37.27% of total billed charges,23.63,37.27,,18.9,percent of total billed charges,37.27% of total billed charges,23.63,37.27,,18.9,percent of total billed charges,37.27% 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,25.36,40,,20.29,percent of total billed charges,40% of total billed charges,23.63,50.72,
NASACORT ALLERGY 24H,6400014,CDM,250,RC,,,Outpatient,,,45.85,36.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36.68,80,,29.34,percent of total billed charges,80% of total billed charges,17.09,37.27,,13.67,percent of total billed charges,37.27% of total billed charges,17.09,37.27,,13.67,percent of total billed charges,37.27% of total billed charges,17.09,37.27,,13.67,percent of total billed charges,37.27% 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,18.34,40,,14.67,percent of total billed charges,40% of total billed charges,17.09,36.68,
SPH SINUS DIL 6 X 17,5801832,CDM,272,RC,,,Outpatient,,,1125,900.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,900,80,,720,percent of total billed charges,80% of total billed charges,419.29,37.27,,335.43,percent of total billed charges,37.27% of total billed charges,419.29,37.27,,335.43,percent of total billed charges,37.27% of total billed charges,419.29,37.27,,335.43,percent of total billed charges,37.27% 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,450,40,,360,percent of total billed charges,40% of total billed charges,419.29,900,
MAX SINUS DIL 6 X 7,5801832,CDM,272,RC,,,Outpatient,,,1425,1140.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1140,80,,912,percent of total billed charges,80% of total billed charges,531.1,37.27,,424.88,percent of total billed charges,37.27% of total billed charges,531.1,37.27,,424.88,percent of total billed charges,37.27% of total billed charges,531.1,37.27,,424.88,percent of total billed charges,37.27% 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,570,40,,456,percent of total billed charges,40% of total billed charges,531.1,1140,
SINUS INFLATOR,5801832,CDM,272,RC,,,Outpatient,,,600,480.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,480,80,,384,percent of total billed charges,80% of total billed charges,223.62,37.27,,178.9,percent of total billed charges,37.27% of total billed charges,223.62,37.27,,178.9,percent of total billed charges,37.27% of total billed charges,223.62,37.27,,178.9,percent of total billed charges,37.27% 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,240,40,,192,percent of total billed charges,40% of total billed charges,223.62,480,
INSTRUMENT TRACKER,5801832,CDM,272,RC,,,Outpatient,,,453,362.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,362.4,80,,289.92,percent of total billed charges,80% of total billed charges,168.83,37.27,,135.06,percent of total billed charges,37.27% of total billed charges,168.83,37.27,,135.06,percent of total billed charges,37.27% of total billed charges,168.83,37.27,,135.06,percent of total billed charges,37.27% 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,181.2,40,,144.96,percent of total billed charges,40% of total billed charges,168.83,362.4,
QUADCUT 4.3MM X 13CM,5801832,CDM,272,RC,,,Outpatient,,,906.75,725.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,725.4,80,,580.32,percent of total billed charges,80% of total billed charges,337.95,37.27,,270.36,percent of total billed charges,37.27% of total billed charges,337.95,37.27,,270.36,percent of total billed charges,37.27% of total billed charges,337.95,37.27,,270.36,percent of total billed charges,37.27% 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,362.7,40,,290.16,percent of total billed charges,40% of total billed charges,337.95,725.4,
FRT SINUS DIL 6 X 17,5801832,CDM,272,RC,,,Outpatient,,,1950,1560.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1560,80,,1248,percent of total billed charges,80% of total billed charges,726.77,37.27,,581.42,percent of total billed charges,37.27% of total billed charges,726.77,37.27,,581.42,percent of total billed charges,37.27% of total billed charges,726.77,37.27,,581.42,percent of total billed charges,37.27% 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,780,40,,624,percent of total billed charges,40% of total billed charges,726.77,1560,
ADHESIVE PAD ENT,5801832,CDM,272,RC,,,Outpatient,,,25,20.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,80,,16,percent of total billed charges,80% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% of total billed charges,9.32,37.27,,7.46,percent of total billed charges,37.27% 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,10,40,,8,percent of total billed charges,40% of total billed charges,9.32,20,
PATIENT TRACKER,5801832,CDM,272,RC,,,Outpatient,,,579,463.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,463.2,80,,370.56,percent of total billed charges,80% of total billed charges,215.79,37.27,,172.63,percent of total billed charges,37.27% of total billed charges,215.79,37.27,,172.63,percent of total billed charges,37.27% of total billed charges,215.79,37.27,,172.63,percent of total billed charges,37.27% 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,231.6,40,,185.28,percent of total billed charges,40% of total billed charges,215.79,463.2,
5 HR GTT,7000029,CDM,301,RC,,,Outpatient,,,136,108.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% 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,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,50.69,108.8,
MULTIPLEX ANTIBODY,7000268,CDM,310,RC,88344,HCPCS,Outpatient,,,239,191.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,191.2,80,,152.96,percent of total billed charges,80% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,89.08,37.27,,71.26,percent of total billed charges,37.27% of total billed charges,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,172.64,145,,,fee schedule,145% of CMS fee schedule,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,296.36,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.6,40,,76.48,percent of total billed charges,40% of total billed charges,89.08,296.36,
QUADCUT 3.0 & 3.4 BL,5801832,CDM,272,RC,,,Outpatient,,,906.75,725.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,725.4,80,,580.32,percent of total billed charges,80% of total billed charges,337.95,37.27,,270.36,percent of total billed charges,37.27% of total billed charges,337.95,37.27,,270.36,percent of total billed charges,37.27% of total billed charges,337.95,37.27,,270.36,percent of total billed charges,37.27% 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,362.7,40,,290.16,percent of total billed charges,40% of total billed charges,337.95,725.4,
POTASSIUM PHOSPHATE,6400014,CDM,250,RC,,,Outpatient,,,60.6,48.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.48,80,,38.78,percent of total billed charges,80% of total billed charges,22.59,37.27,,18.07,percent of total billed charges,37.27% of total billed charges,22.59,37.27,,18.07,percent of total billed charges,37.27% of total billed charges,22.59,37.27,,18.07,percent of total billed charges,37.27% 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,24.24,40,,19.39,percent of total billed charges,40% of total billed charges,22.59,48.48,
MILK OF MAG 500MG,5880901,CDM,637,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
NERVE LOCATOR,5801832,CDM,272,RC,,,Outpatient,,,255.15,204.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.12,80,,163.3,percent of total billed charges,80% of total billed charges,95.09,37.27,,76.07,percent of total billed charges,37.27% of total billed charges,95.09,37.27,,76.07,percent of total billed charges,37.27% of total billed charges,95.09,37.27,,76.07,percent of total billed charges,37.27% 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,102.06,40,,81.65,percent of total billed charges,40% of total billed charges,95.09,204.12,
METOPROLOL TART 25MG,5880901,CDM,637,RC,,,Outpatient,,,1.85,1.48,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
US VASC ACCESS GUIDA,6000566,CDM,402,RC,76937,HCPCS,Outpatient,,,428,342.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,342.4,80,,273.92,percent of total billed charges,80% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.41,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,171.2,40,,136.96,percent of total billed charges,40% of total billed charges,31.41,342.4,
MEDROXY 2.5MG,5880901,CDM,637,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
NEOSTIGMINE 1MG/ML 5,6065130,CDM,636,RC,J2710,HCPCS,Outpatient,,,144.9,115.92,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.92,80,,92.74,percent of total billed charges,80% of total billed charges,54,37.27,,43.2,percent of total billed charges,37.27% of total billed charges,54,37.27,,43.2,percent of total billed charges,37.27% of total billed charges,54,37.27,,43.2,percent of total billed charges,37.27% 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,57.96,40,,46.37,percent of total billed charges,40% of total billed charges,54,115.92,
INFANRIX,6400014,CDM,250,RC,,,Outpatient,,,116.3,93.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,93.04,80,,74.43,percent of total billed charges,80% of total billed charges,43.35,37.27,,34.68,percent of total billed charges,37.27% of total billed charges,43.35,37.27,,34.68,percent of total billed charges,37.27% of total billed charges,43.35,37.27,,34.68,percent of total billed charges,37.27% 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,46.52,40,,37.22,percent of total billed charges,40% of total billed charges,43.35,93.04,
THUNDERBEAT HANDPIEC,5801832,CDM,272,RC,,,Outpatient,,,1260,1008.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1008,80,,806.4,percent of total billed charges,80% of total billed charges,469.6,37.27,,375.68,percent of total billed charges,37.27% of total billed charges,469.6,37.27,,375.68,percent of total billed charges,37.27% of total billed charges,469.6,37.27,,375.68,percent of total billed charges,37.27% 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,504,40,,403.2,percent of total billed charges,40% of total billed charges,469.6,1008,
AVEENO LOTION,5880901,CDM,637,RC,,,Outpatient,,,17.75,14.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.2,80,,11.36,percent of total billed charges,80% of total billed charges,6.62,37.27,,5.3,percent of total billed charges,37.27% of total billed charges,6.62,37.27,,5.3,percent of total billed charges,37.27% of total billed charges,6.62,37.27,,5.3,percent of total billed charges,37.27% 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,7.1,40,,5.68,percent of total billed charges,40% of total billed charges,6.62,14.2,
FARXIGA 5MG TAB,5880901,CDM,637,RC,,,Outpatient,,,79.4,63.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.52,80,,50.82,percent of total billed charges,80% of total billed charges,29.59,37.27,,23.67,percent of total billed charges,37.27% of total billed charges,29.59,37.27,,23.67,percent of total billed charges,37.27% of total billed charges,29.59,37.27,,23.67,percent of total billed charges,37.27% 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,31.76,40,,25.41,percent of total billed charges,40% of total billed charges,29.59,63.52,
AMOXICILLIN 125MG TA,6400014,CDM,250,RC,,,Outpatient,,,3.95,3.16,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.16,80,,2.53,percent of total billed charges,80% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% of total billed charges,1.47,37.27,,1.18,percent of total billed charges,37.27% 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,1.58,40,,1.26,percent of total billed charges,40% of total billed charges,1.47,3.16,
NAVIGATION/SINUS SUR,8612012,CDM,360,RC,61782,HCPCS,Outpatient,,,683,546.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,546.4,80,,437.12,percent of total billed charges,80% of total billed charges,254.55,37.27,,203.64,percent of total billed charges,37.27% of total billed charges,254.55,37.27,,203.64,percent of total billed charges,37.27% of total billed charges,254.55,37.27,,203.64,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,242.01,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,273.2,40,,218.56,percent of total billed charges,40% of total billed charges,242.01,546.4,
NAMENDA XR 21MG,6400014,CDM,250,RC,,,Outpatient,,,63.4,50.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.72,80,,40.58,percent of total billed charges,80% of total billed charges,23.63,37.27,,18.9,percent of total billed charges,37.27% of total billed charges,23.63,37.27,,18.9,percent of total billed charges,37.27% of total billed charges,23.63,37.27,,18.9,percent of total billed charges,37.27% 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,25.36,40,,20.29,percent of total billed charges,40% of total billed charges,23.63,50.72,
NAMENDA XR 14MG,6400014,CDM,250,RC,,,Outpatient,,,63.4,50.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.72,80,,40.58,percent of total billed charges,80% of total billed charges,23.63,37.27,,18.9,percent of total billed charges,37.27% of total billed charges,23.63,37.27,,18.9,percent of total billed charges,37.27% of total billed charges,23.63,37.27,,18.9,percent of total billed charges,37.27% 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,25.36,40,,20.29,percent of total billed charges,40% of total billed charges,23.63,50.72,
ZINC OXIDE 1LB,6400014,CDM,250,RC,,,Outpatient,,,30.3,24.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.24,80,,19.39,percent of total billed charges,80% of total billed charges,11.29,37.27,,9.03,percent of total billed charges,37.27% of total billed charges,11.29,37.27,,9.03,percent of total billed charges,37.27% of total billed charges,11.29,37.27,,9.03,percent of total billed charges,37.27% 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,12.12,40,,9.7,percent of total billed charges,40% of total billed charges,11.29,24.24,
PROPOFOL  50ML,6065130,CDM,636,RC,J2704,HCPCS,Outpatient,,,58.3,46.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.64,80,,37.31,percent of total billed charges,80% of total billed charges,21.73,37.27,,17.38,percent of total billed charges,37.27% of total billed charges,21.73,37.27,,17.38,percent of total billed charges,37.27% of total billed charges,21.73,37.27,,17.38,percent of total billed charges,37.27% 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,23.32,40,,18.66,percent of total billed charges,40% of total billed charges,21.73,46.64,
VASOSTRICT,6400014,CDM,250,RC,,,Outpatient,,,0.01,0.01,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,80,,0.01,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,0.01,0.01,
VASOSTRICT 20UNITS/M,6065130,CDM,636,RC,J2598,HCPCS,Outpatient,,,290.55,232.44,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,232.44,80,,185.95,percent of total billed charges,80% of total billed charges,108.29,37.27,,86.63,percent of total billed charges,37.27% of total billed charges,108.29,37.27,,86.63,percent of total billed charges,37.27% of total billed charges,108.29,37.27,,86.63,percent of total billed charges,37.27% of total billed charges,1.62,100,,,fee schedule,100% of APC rate,1.62,100,,,fee schedule,100% of APC rate,1.62,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1.62,100,,,fee schedule,100% of APC rate,1.62,100,,,fee schedule,100% of APC rate,1.62,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.22,40,,92.98,percent of total billed charges,40% of total billed charges,1.62,232.44,
NON-FORMULARY,6400014,CDM,250,RC,,,Outpatient,,,0.01,0.01,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,80,,0.01,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,0.01,0.01,
CATECHOLAMINES RANDO,7018237,CDM,307,RC,,,Outpatient,,,193,154.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.4,80,,123.52,percent of total billed charges,80% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% 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,77.2,40,,61.76,percent of total billed charges,40% of total billed charges,71.93,154.4,
PROPOFOL 50ML,6065130,CDM,636,RC,J2704,HCPCS,Outpatient,,,17.1,13.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.68,80,,10.94,percent of total billed charges,80% of total billed charges,6.37,37.27,,5.1,percent of total billed charges,37.27% of total billed charges,6.37,37.27,,5.1,percent of total billed charges,37.27% of total billed charges,6.37,37.27,,5.1,percent of total billed charges,37.27% 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,6.84,40,,5.47,percent of total billed charges,40% of total billed charges,6.37,13.68,
CLINDAMYCIN 900MGADV,6065130,CDM,636,RC,J0736,HCPCS,Outpatient,,,38.95,31.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.16,80,,24.93,percent of total billed charges,80% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,2.47,100,,,fee schedule,100% of APC rate,2.47,100,,,fee schedule,100% of APC rate,2.47,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,2.47,100,,,fee schedule,100% of APC rate,2.47,100,,,fee schedule,100% of APC rate,2.47,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15.58,40,,12.46,percent of total billed charges,40% of total billed charges,2.47,31.16,
VANCOMYCIN 1GM ADV,6065130,CDM,636,RC,J3370,HCPCS,Outpatient,,,44.4,35.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.52,80,,28.42,percent of total billed charges,80% of total billed charges,16.55,37.27,,13.24,percent of total billed charges,37.27% of total billed charges,16.55,37.27,,13.24,percent of total billed charges,37.27% of total billed charges,16.55,37.27,,13.24,percent of total billed charges,37.27% 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,17.76,40,,14.21,percent of total billed charges,40% of total billed charges,16.55,35.52,
VANCOMYCIN 500MG ADV,6065130,CDM,636,RC,J3370,HCPCS,Outpatient,,,38.95,31.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.16,80,,24.93,percent of total billed charges,80% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% 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,15.58,40,,12.46,percent of total billed charges,40% of total billed charges,14.52,31.16,
OXYTOCIN 20UN INJ,6400014,CDM,250,RC,,,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
IMIPENUM-CIL 500MG,6400014,CDM,250,RC,,,Outpatient,,,122.65,98.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.12,80,,78.5,percent of total billed charges,80% of total billed charges,45.71,37.27,,36.57,percent of total billed charges,37.27% of total billed charges,45.71,37.27,,36.57,percent of total billed charges,37.27% of total billed charges,45.71,37.27,,36.57,percent of total billed charges,37.27% 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,49.06,40,,39.25,percent of total billed charges,40% of total billed charges,45.71,98.12,
NOVOLOG INSULIN,6400014,CDM,250,RC,,,Outpatient,,,52,41.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% 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,20.8,40,,16.64,percent of total billed charges,40% of total billed charges,19.38,41.6,
ENTRESTO 24/26MG,5880901,CDM,637,RC,,,Outpatient,,,63.95,51.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.16,80,,40.93,percent of total billed charges,80% of total billed charges,23.83,37.27,,19.06,percent of total billed charges,37.27% of total billed charges,23.83,37.27,,19.06,percent of total billed charges,37.27% of total billed charges,23.83,37.27,,19.06,percent of total billed charges,37.27% 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,25.58,40,,20.46,percent of total billed charges,40% of total billed charges,23.83,51.16,
C-TOPICAL 4%,5880901,CDM,637,RC,,,Outpatient,,,132.49,105.99,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.99,80,,84.79,percent of total billed charges,80% of total billed charges,49.38,37.27,,39.5,percent of total billed charges,37.27% of total billed charges,49.38,37.27,,39.5,percent of total billed charges,37.27% of total billed charges,49.38,37.27,,39.5,percent of total billed charges,37.27% 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,53,40,,42.4,percent of total billed charges,40% of total billed charges,49.38,105.99,
OXYTOCIN 10 UNITS/ML,6065130,CDM,636,RC,J2590,HCPCS,Outpatient,,,14.1,11.28,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.28,80,,9.02,percent of total billed charges,80% of total billed charges,5.26,37.27,,4.21,percent of total billed charges,37.27% of total billed charges,5.26,37.27,,4.21,percent of total billed charges,37.27% of total billed charges,5.26,37.27,,4.21,percent of total billed charges,37.27% 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,5.64,40,,4.51,percent of total billed charges,40% of total billed charges,5.26,11.28,
NOVOLOG,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,90.86,72.69,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.69,80,,58.15,percent of total billed charges,80% of total billed charges,33.86,37.27,,27.09,percent of total billed charges,37.27% of total billed charges,33.86,37.27,,27.09,percent of total billed charges,37.27% of total billed charges,33.86,37.27,,27.09,percent of total billed charges,37.27% 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,36.34,40,,29.07,percent of total billed charges,40% of total billed charges,33.86,72.69,
ANZEMET 20MG/ML INJ,6065130,CDM,636,RC,,,Outpatient,,,95.3,76.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.24,80,,60.99,percent of total billed charges,80% of total billed charges,35.52,37.27,,28.42,percent of total billed charges,37.27% of total billed charges,35.52,37.27,,28.42,percent of total billed charges,37.27% of total billed charges,35.52,37.27,,28.42,percent of total billed charges,37.27% 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,38.12,40,,30.5,percent of total billed charges,40% of total billed charges,35.52,76.24,
PT ESTIM UNATTENDED,6610133,CDM,420,RC,97014,HCPCS,Outpatient,,,87,69.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.85,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,40,,27.84,percent of total billed charges,40% of total billed charges,16.85,69.6,
OT ESTIM UNATTENDED,6510135,CDM,430,RC,97014,HCPCS,Outpatient,,,87,69.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.6,80,,55.68,percent of total billed charges,80% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,32.42,37.27,,25.94,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.85,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.8,40,,27.84,percent of total billed charges,40% of total billed charges,16.85,69.6,
OT COG SKILLS EA 15M,6510135,CDM,430,RC,97127,HCPCS,Outpatient,,,112,89.60,GO,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,80,,71.68,percent of total billed charges,80% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% of total billed charges,41.74,37.27,,33.39,percent of total billed charges,37.27% 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,44.8,40,,35.84,percent of total billed charges,40% of total billed charges,41.74,89.6,
DRESS PROMOGRAN 4.34,5801832,CDM,272,RC,,,Outpatient,,,38.4,30.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.72,80,,24.58,percent of total billed charges,80% of total billed charges,14.31,37.27,,11.45,percent of total billed charges,37.27% of total billed charges,14.31,37.27,,11.45,percent of total billed charges,37.27% of total billed charges,14.31,37.27,,11.45,percent of total billed charges,37.27% 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,15.36,40,,12.29,percent of total billed charges,40% of total billed charges,14.31,30.72,
DRSG PRISM 4.34 SQIN,5801832,CDM,272,RC,,,Outpatient,,,46.85,37.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.48,80,,29.98,percent of total billed charges,80% of total billed charges,17.46,37.27,,13.97,percent of total billed charges,37.27% of total billed charges,17.46,37.27,,13.97,percent of total billed charges,37.27% of total billed charges,17.46,37.27,,13.97,percent of total billed charges,37.27% 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,18.74,40,,14.99,percent of total billed charges,40% of total billed charges,17.46,37.48,
FACTOR IX INH PROFIL,7000029,CDM,301,RC,,,Outpatient,,,253,202.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.4,80,,161.92,percent of total billed charges,80% of total billed charges,94.29,37.27,,75.43,percent of total billed charges,37.27% of total billed charges,94.29,37.27,,75.43,percent of total billed charges,37.27% of total billed charges,94.29,37.27,,75.43,percent of total billed charges,37.27% 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,101.2,40,,80.96,percent of total billed charges,40% of total billed charges,94.29,202.4,
FACTOR II INH PROFIL,7000029,CDM,301,RC,,,Outpatient,,,58,46.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% 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,23.2,40,,18.56,percent of total billed charges,40% of total billed charges,21.62,46.4,
FACTOR V INH PRO COM,7000029,CDM,301,RC,,,Outpatient,,,252,201.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,80,,161.28,percent of total billed charges,80% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% 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,100.8,40,,80.64,percent of total billed charges,40% of total billed charges,93.92,201.6,
FACTOR VIII INH PROF,7000029,CDM,301,RC,,,Outpatient,,,253,202.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,202.4,80,,161.92,percent of total billed charges,80% of total billed charges,94.29,37.27,,75.43,percent of total billed charges,37.27% of total billed charges,94.29,37.27,,75.43,percent of total billed charges,37.27% of total billed charges,94.29,37.27,,75.43,percent of total billed charges,37.27% 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,101.2,40,,80.96,percent of total billed charges,40% of total billed charges,94.29,202.4,
DEXILANT,5880901,CDM,637,RC,,,Outpatient,,,42.05,33.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,33.64,80,,26.91,percent of total billed charges,80% of total billed charges,15.67,37.27,,12.54,percent of total billed charges,37.27% of total billed charges,15.67,37.27,,12.54,percent of total billed charges,37.27% of total billed charges,15.67,37.27,,12.54,percent of total billed charges,37.27% 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,16.82,40,,13.46,percent of total billed charges,40% of total billed charges,15.67,33.64,
APPL COMP BELOW BIL,5612346,CDM,761,RC,29581,HCPCS,Outpatient,,,750.6,600.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600.48,80,,480.38,percent of total billed charges,80% of total billed charges,279.75,37.27,,223.8,percent of total billed charges,37.27% of total billed charges,279.75,37.27,,223.8,percent of total billed charges,37.27% of total billed charges,279.75,37.27,,223.8,percent of total billed charges,37.27% of total billed charges,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,37.12,145,,,fee schedule,145% of CMS fee schedule,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,129.91,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300.24,40,,240.19,percent of total billed charges,40% of total billed charges,37.12,600.48,
INTUBATION NURSERY,8400010,CDM,760,RC,31500,HCPCS,Outpatient,,,646,516.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,199.82,145,,,fee schedule,145% of CMS fee schedule,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,258.4,40,,206.72,percent of total billed charges,40% of total billed charges,199.82,516.8,
NIFEDIPINE ER 60MG,6400014,CDM,250,RC,,,Outpatient,,,7.65,6.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.12,80,,4.9,percent of total billed charges,80% of total billed charges,2.85,37.27,,2.28,percent of total billed charges,37.27% of total billed charges,2.85,37.27,,2.28,percent of total billed charges,37.27% of total billed charges,2.85,37.27,,2.28,percent of total billed charges,37.27% 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,3.06,40,,2.45,percent of total billed charges,40% of total billed charges,2.85,6.12,
REFLUX ULTRA 45,5801832,CDM,272,RC,,,Outpatient,,,675,540.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540,80,,432,percent of total billed charges,80% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% 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,270,40,,216,percent of total billed charges,40% of total billed charges,251.57,540,
OT APPL SPLINT FNGR,6510135,CDM,430,RC,29131,HCPCS,Outpatient,,,211,168.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.8,80,,135.04,percent of total billed charges,80% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,48.42,145,,,fee schedule,145% of CMS fee schedule,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84.4,40,,67.52,percent of total billed charges,40% of total billed charges,48.42,168.8,
FLULAVAL 2015-2016,6065130,CDM,636,RC,90688,HCPCS,Outpatient,,,129.05,103.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.24,80,,82.59,percent of total billed charges,80% of total billed charges,48.1,37.27,,38.48,percent of total billed charges,37.27% of total billed charges,48.1,37.27,,38.48,percent of total billed charges,37.27% of total billed charges,48.1,37.27,,38.48,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.48,100,,,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,51.62,40,,41.3,percent of total billed charges,40% of total billed charges,20.48,103.24,
FIBROSURE NASH,7000029,CDM,301,RC,,,Outpatient,,,361,288.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288.8,80,,231.04,percent of total billed charges,80% of total billed charges,134.54,37.27,,107.63,percent of total billed charges,37.27% of total billed charges,134.54,37.27,,107.63,percent of total billed charges,37.27% of total billed charges,134.54,37.27,,107.63,percent of total billed charges,37.27% 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,144.4,40,,115.52,percent of total billed charges,40% of total billed charges,134.54,288.8,
TRAXI EXTENDER,5801832,CDM,272,RC,,,Outpatient,,,236.25,189.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189,80,,151.2,percent of total billed charges,80% of total billed charges,88.05,37.27,,70.44,percent of total billed charges,37.27% of total billed charges,88.05,37.27,,70.44,percent of total billed charges,37.27% of total billed charges,88.05,37.27,,70.44,percent of total billed charges,37.27% 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,94.5,40,,75.6,percent of total billed charges,40% of total billed charges,88.05,189,
TRAXI RETRACTOR,5801832,CDM,272,RC,,,Outpatient,,,337.5,270.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,270,80,,216,percent of total billed charges,80% of total billed charges,125.79,37.27,,100.63,percent of total billed charges,37.27% of total billed charges,125.79,37.27,,100.63,percent of total billed charges,37.27% of total billed charges,125.79,37.27,,100.63,percent of total billed charges,37.27% 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,135,40,,108,percent of total billed charges,40% of total billed charges,125.79,270,
ALCOHOL (BLOOD) COC,7000029,CDM,301,RC,80320,HCPCS,Outpatient,,,280,224.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224,80,,179.2,percent of total billed charges,80% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% 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,112,40,,89.6,percent of total billed charges,40% of total billed charges,104.36,224,
KCL 20MEQ/100ML IVPB,6065130,CDM,636,RC,J3480,HCPCS,Outpatient,,,1.32,1.06,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.06,80,,0.85,percent of total billed charges,80% of total billed charges,0.49,37.27,,0.39,percent of total billed charges,37.27% of total billed charges,0.49,37.27,,0.39,percent of total billed charges,37.27% of total billed charges,0.49,37.27,,0.39,percent of total billed charges,37.27% 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,0.53,40,,0.42,percent of total billed charges,40% of total billed charges,0.49,1.06,
BRILINTA 90MG,6400014,CDM,250,RC,,,Outpatient,,,5.71,4.57,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.57,80,,3.66,percent of total billed charges,80% of total billed charges,2.13,37.27,,1.7,percent of total billed charges,37.27% of total billed charges,2.13,37.27,,1.7,percent of total billed charges,37.27% of total billed charges,2.13,37.27,,1.7,percent of total billed charges,37.27% 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,2.28,40,,1.82,percent of total billed charges,40% of total billed charges,2.13,4.57,
DRESSING AQUACEL 4X5,5801832,CDM,272,RC,,,Outpatient,,,44.55,35.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.64,80,,28.51,percent of total billed charges,80% of total billed charges,16.6,37.27,,13.28,percent of total billed charges,37.27% of total billed charges,16.6,37.27,,13.28,percent of total billed charges,37.27% of total billed charges,16.6,37.27,,13.28,percent of total billed charges,37.27% 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,17.82,40,,14.26,percent of total billed charges,40% of total billed charges,16.6,35.64,
PLEUR-EVAC ADULT TUB,5801832,CDM,272,RC,,,Outpatient,,,156.3,125.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,125.04,80,,100.03,percent of total billed charges,80% of total billed charges,58.25,37.27,,46.6,percent of total billed charges,37.27% of total billed charges,58.25,37.27,,46.6,percent of total billed charges,37.27% of total billed charges,58.25,37.27,,46.6,percent of total billed charges,37.27% 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,62.52,40,,50.02,percent of total billed charges,40% of total billed charges,58.25,125.04,
PLEUR-EVAC PEDI TUBE,5801832,CDM,272,RC,,,Outpatient,,,207.55,166.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.04,80,,132.83,percent of total billed charges,80% of total billed charges,77.35,37.27,,61.88,percent of total billed charges,37.27% of total billed charges,77.35,37.27,,61.88,percent of total billed charges,37.27% of total billed charges,77.35,37.27,,61.88,percent of total billed charges,37.27% 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,83.02,40,,66.42,percent of total billed charges,40% of total billed charges,77.35,166.04,
XIFAXIN 550MG,6400014,CDM,250,RC,,,Outpatient,,,189.5,151.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.6,80,,121.28,percent of total billed charges,80% of total billed charges,70.63,37.27,,56.5,percent of total billed charges,37.27% of total billed charges,70.63,37.27,,56.5,percent of total billed charges,37.27% of total billed charges,70.63,37.27,,56.5,percent of total billed charges,37.27% 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,75.8,40,,60.64,percent of total billed charges,40% of total billed charges,70.63,151.6,
PYLORITEK TEST KIT,5801832,CDM,272,RC,,,Outpatient,,,42.5,34.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34,80,,27.2,percent of total billed charges,80% of total billed charges,15.84,37.27,,12.67,percent of total billed charges,37.27% of total billed charges,15.84,37.27,,12.67,percent of total billed charges,37.27% of total billed charges,15.84,37.27,,12.67,percent of total billed charges,37.27% 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,17,40,,13.6,percent of total billed charges,40% of total billed charges,15.84,34,
EFFEXOR 50MG TABLET,5880901,CDM,637,RC,,,Outpatient,,,7,5.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.6,80,,4.48,percent of total billed charges,80% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% of total billed charges,2.61,37.27,,2.09,percent of total billed charges,37.27% 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,2.8,40,,2.24,percent of total billed charges,40% of total billed charges,2.61,5.6,
XYLOCAINE-MPF 2%-5ML,6065130,CDM,636,RC,J2003,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
FLUZONE HI DOSE >65,6065130,CDM,636,RC,90662,HCPCS,Outpatient,,,306.7,245.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,245.36,80,,196.29,percent of total billed charges,80% of total billed charges,114.31,37.27,,91.45,percent of total billed charges,37.27% of total billed charges,114.31,37.27,,91.45,percent of total billed charges,37.27% of total billed charges,114.31,37.27,,91.45,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.94,100,,,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,122.68,40,,98.14,percent of total billed charges,40% of total billed charges,69.94,245.36,
DAKIN'S 1/4 SOLUTION,5880901,CDM,637,RC,,,Outpatient,,,47.2,37.76,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.76,80,,30.21,percent of total billed charges,80% of total billed charges,17.59,37.27,,14.07,percent of total billed charges,37.27% of total billed charges,17.59,37.27,,14.07,percent of total billed charges,37.27% of total billed charges,17.59,37.27,,14.07,percent of total billed charges,37.27% 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,18.88,40,,15.1,percent of total billed charges,40% of total billed charges,17.59,37.76,
MINOR SURG PROC IV,8400010,CDM,760,RC,SURG,HCPCS,Outpatient,,,3689,2951.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2951.2,80,,2360.96,percent of total billed charges,80% of total billed charges,1374.89,37.27,,1099.91,percent of total billed charges,37.27% of total billed charges,1374.89,37.27,,1099.91,percent of total billed charges,37.27% of total billed charges,1374.89,37.27,,1099.91,percent of total billed charges,37.27% 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,1475.6,40,,1180.48,percent of total billed charges,40% of total billed charges,1374.89,2951.2,
TYPHOID VACCINE,6400014,CDM,250,RC,,,Outpatient,,,1008.4,806.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,806.72,80,,645.38,percent of total billed charges,80% of total billed charges,375.83,37.27,,300.66,percent of total billed charges,37.27% of total billed charges,375.83,37.27,,300.66,percent of total billed charges,37.27% of total billed charges,375.83,37.27,,300.66,percent of total billed charges,37.27% 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,403.36,40,,322.69,percent of total billed charges,40% of total billed charges,375.83,806.72,
FENTANYL,7000029,CDM,301,RC,80354,HCPCS,Outpatient,,,179.25,143.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.4,80,,114.72,percent of total billed charges,80% of total billed charges,66.81,37.27,,53.45,percent of total billed charges,37.27% of total billed charges,66.81,37.27,,53.45,percent of total billed charges,37.27% of total billed charges,66.81,37.27,,53.45,percent of total billed charges,37.27% 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,71.7,40,,57.36,percent of total billed charges,40% of total billed charges,66.81,143.4,
ABREVA 10%,6400014,CDM,250,RC,,,Outpatient,,,60.11,48.09,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.09,80,,38.47,percent of total billed charges,80% of total billed charges,22.4,37.27,,17.92,percent of total billed charges,37.27% of total billed charges,22.4,37.27,,17.92,percent of total billed charges,37.27% of total billed charges,22.4,37.27,,17.92,percent of total billed charges,37.27% 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,24.04,40,,19.23,percent of total billed charges,40% of total billed charges,22.4,48.09,
AUTO CBC & MAN DIFF,7000177,CDM,305,RC,,,Outpatient,,,42.84,34.27,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.27,80,,27.42,percent of total billed charges,80% of total billed charges,15.97,37.27,,12.78,percent of total billed charges,37.27% of total billed charges,15.97,37.27,,12.78,percent of total billed charges,37.27% of total billed charges,15.97,37.27,,12.78,percent of total billed charges,37.27% 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,17.14,40,,13.71,percent of total billed charges,40% of total billed charges,15.97,34.27,
LOVENOX 300MG/3ML,6065130,CDM,636,RC,J1650,HCPCS,Outpatient,,,96,76.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% 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,38.4,40,,30.72,percent of total billed charges,40% of total billed charges,35.78,76.8,
CLINDAMYCIN 900MG PM,6065130,CDM,636,RC,J0736,HCPCS,Outpatient,,,61.8,49.44,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.44,80,,39.55,percent of total billed charges,80% of total billed charges,23.03,37.27,,18.42,percent of total billed charges,37.27% of total billed charges,23.03,37.27,,18.42,percent of total billed charges,37.27% of total billed charges,23.03,37.27,,18.42,percent of total billed charges,37.27% of total billed charges,2.47,100,,,fee schedule,100% of APC rate,2.47,100,,,fee schedule,100% of APC rate,2.47,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,2.47,100,,,fee schedule,100% of APC rate,2.47,100,,,fee schedule,100% of APC rate,2.47,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24.72,40,,19.78,percent of total billed charges,40% of total billed charges,2.47,49.44,
COMP KIDNEY STONE PA,7000029,CDM,301,RC,,,Outpatient,,,1020.68,816.54,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,816.54,80,,653.23,percent of total billed charges,80% of total billed charges,380.41,37.27,,304.33,percent of total billed charges,37.27% of total billed charges,380.41,37.27,,304.33,percent of total billed charges,37.27% of total billed charges,380.41,37.27,,304.33,percent of total billed charges,37.27% 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,408.27,40,,326.62,percent of total billed charges,40% of total billed charges,380.41,816.54,
OXYCODONE,7000029,CDM,301,RC,80365,HCPCS,Outpatient,,,120,96.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% 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,48,40,,38.4,percent of total billed charges,40% of total billed charges,44.72,96,
TRAMADOL,7000029,CDM,301,RC,80373,HCPCS,Outpatient,,,120,96.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% 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,48,40,,38.4,percent of total billed charges,40% of total billed charges,44.72,96,
BUPRENORPHINE,7000029,CDM,301,RC,80348,HCPCS,Outpatient,,,120,96.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% 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,48,40,,38.4,percent of total billed charges,40% of total billed charges,44.72,96,
METHYLENEDIOXYAMPHET,7000029,CDM,301,RC,80359,HCPCS,Outpatient,,,120,96.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% 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,48,40,,38.4,percent of total billed charges,40% of total billed charges,44.72,96,
COCAINE,7000029,CDM,301,RC,80353,HCPCS,Outpatient,,,120,96.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% 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,48,40,,38.4,percent of total billed charges,40% of total billed charges,44.72,96,
PROPOXPHENE,7000029,CDM,301,RC,80367,HCPCS,Outpatient,,,120,96.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% 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,48,40,,38.4,percent of total billed charges,40% of total billed charges,44.72,96,
TOXASSURE SELECT,7000029,CDM,301,RC,,,Outpatient,,,2015.83,1612.66,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1612.66,80,,1290.13,percent of total billed charges,80% of total billed charges,751.3,37.27,,601.04,percent of total billed charges,37.27% of total billed charges,751.3,37.27,,601.04,percent of total billed charges,37.27% of total billed charges,751.3,37.27,,601.04,percent of total billed charges,37.27% 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,806.33,40,,645.06,percent of total billed charges,40% of total billed charges,751.3,1612.66,
CATH HYSTEROSALPINGO,5801832,CDM,272,RC,,,Outpatient,,,129.55,103.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.64,80,,82.91,percent of total billed charges,80% of total billed charges,48.28,37.27,,38.62,percent of total billed charges,37.27% of total billed charges,48.28,37.27,,38.62,percent of total billed charges,37.27% of total billed charges,48.28,37.27,,38.62,percent of total billed charges,37.27% 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,51.82,40,,41.46,percent of total billed charges,40% of total billed charges,48.28,103.64,
NAROPIN 200MG/100MG,6400014,CDM,250,RC,,,Outpatient,,,158.05,126.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.44,80,,101.15,percent of total billed charges,80% of total billed charges,58.91,37.27,,47.13,percent of total billed charges,37.27% of total billed charges,58.91,37.27,,47.13,percent of total billed charges,37.27% of total billed charges,58.91,37.27,,47.13,percent of total billed charges,37.27% 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,63.22,40,,50.58,percent of total billed charges,40% of total billed charges,58.91,126.44,
MYASTHENIA GRAVIS EV,7000029,CDM,301,RC,,,Outpatient,,,303,242.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,242.4,80,,193.92,percent of total billed charges,80% of total billed charges,112.93,37.27,,90.34,percent of total billed charges,37.27% of total billed charges,112.93,37.27,,90.34,percent of total billed charges,37.27% of total billed charges,112.93,37.27,,90.34,percent of total billed charges,37.27% 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,121.2,40,,96.96,percent of total billed charges,40% of total billed charges,112.93,242.4,
NM NON-HEU TC-99 DOS,6071625,CDM,343,RC,Q9969,HCPCS,Outpatient,,,20,16.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,80,,12.8,percent of total billed charges,80% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,7.45,37.27,,5.96,percent of total billed charges,37.27% of total billed charges,10,100,,,fee schedule,100% of APC rate,10,100,,,fee schedule,100% of APC rate,10,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,10,100,,,fee schedule,100% of APC rate,10,100,,,fee schedule,100% of APC rate,10,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8,40,,6.4,percent of total billed charges,40% of total billed charges,7.45,16,
ZONISAMIDE 25MG CAP,6400014,CDM,250,RC,,,Outpatient,,,0.01,0.01,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.01,80,,0.01,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,0.01,0.01,
TRANEXAMIC ACID,6400014,CDM,250,RC,,,Outpatient,,,1517.05,1213.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1213.64,80,,970.91,percent of total billed charges,80% of total billed charges,565.4,37.27,,452.32,percent of total billed charges,37.27% of total billed charges,565.4,37.27,,452.32,percent of total billed charges,37.27% of total billed charges,565.4,37.27,,452.32,percent of total billed charges,37.27% 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,606.82,40,,485.46,percent of total billed charges,40% of total billed charges,565.4,1213.64,
IMMUNHISOCHE EA ADD,7080054,CDM,312,RC,88341,HCPCS,Outpatient,,,95,76.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.75,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38,40,,30.4,percent of total billed charges,40% of total billed charges,35.41,80.75,
TUBE HOLDER LARGE ET,5801832,CDM,272,RC,,,Outpatient,,,81.85,65.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.48,80,,52.38,percent of total billed charges,80% of total billed charges,30.51,37.27,,24.41,percent of total billed charges,37.27% of total billed charges,30.51,37.27,,24.41,percent of total billed charges,37.27% of total billed charges,30.51,37.27,,24.41,percent of total billed charges,37.27% 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,32.74,40,,26.19,percent of total billed charges,40% of total billed charges,30.51,65.48,
TUBE HOLDER SMALL ET,5801832,CDM,272,RC,,,Outpatient,,,77.15,61.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.72,80,,49.38,percent of total billed charges,80% of total billed charges,28.75,37.27,,23,percent of total billed charges,37.27% of total billed charges,28.75,37.27,,23,percent of total billed charges,37.27% of total billed charges,28.75,37.27,,23,percent of total billed charges,37.27% 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,30.86,40,,24.69,percent of total billed charges,40% of total billed charges,28.75,61.72,
TUBE HOLDER MICRO ET,5801832,CDM,272,RC,,,Outpatient,,,81.85,65.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.48,80,,52.38,percent of total billed charges,80% of total billed charges,30.51,37.27,,24.41,percent of total billed charges,37.27% of total billed charges,30.51,37.27,,24.41,percent of total billed charges,37.27% of total billed charges,30.51,37.27,,24.41,percent of total billed charges,37.27% 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,32.74,40,,26.19,percent of total billed charges,40% of total billed charges,30.51,65.48,
TUBE HOLDER ULTRA ET,5801832,CDM,272,RC,,,Outpatient,,,81.85,65.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,65.48,80,,52.38,percent of total billed charges,80% of total billed charges,30.51,37.27,,24.41,percent of total billed charges,37.27% of total billed charges,30.51,37.27,,24.41,percent of total billed charges,37.27% of total billed charges,30.51,37.27,,24.41,percent of total billed charges,37.27% 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,32.74,40,,26.19,percent of total billed charges,40% of total billed charges,30.51,65.48,
TUBE HOLDER MINI ET,5801832,CDM,272,RC,,,Outpatient,,,77.15,61.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61.72,80,,49.38,percent of total billed charges,80% of total billed charges,28.75,37.27,,23,percent of total billed charges,37.27% of total billed charges,28.75,37.27,,23,percent of total billed charges,37.27% of total billed charges,28.75,37.27,,23,percent of total billed charges,37.27% 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,30.86,40,,24.69,percent of total billed charges,40% of total billed charges,28.75,61.72,
SENSOR INF LNOP INFL,5801832,CDM,272,RC,,,Outpatient,,,52.85,42.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.28,80,,33.82,percent of total billed charges,80% of total billed charges,19.7,37.27,,15.76,percent of total billed charges,37.27% of total billed charges,19.7,37.27,,15.76,percent of total billed charges,37.27% of total billed charges,19.7,37.27,,15.76,percent of total billed charges,37.27% 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,21.14,40,,16.91,percent of total billed charges,40% of total billed charges,19.7,42.28,
"HEPARIN 25,000U/250M",6065130,CDM,636,RC,J1644,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
TRACHEOTOMY TUBE CHG,8400010,CDM,760,RC,31502,HCPCS,Outpatient,,,554,443.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,443.2,80,,354.56,percent of total billed charges,80% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% of total billed charges,206.48,37.27,,165.18,percent of total billed charges,37.27% of total billed charges,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,49.02,145,,,fee schedule,145% of CMS fee schedule,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,201.39,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,221.6,40,,177.28,percent of total billed charges,40% of total billed charges,49.02,443.2,
WOUND PROTECTOR/RETR,5801832,CDM,272,RC,,,Outpatient,,,292.5,234.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234,80,,187.2,percent of total billed charges,80% of total billed charges,109.01,37.27,,87.21,percent of total billed charges,37.27% of total billed charges,109.01,37.27,,87.21,percent of total billed charges,37.27% of total billed charges,109.01,37.27,,87.21,percent of total billed charges,37.27% 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,117,40,,93.6,percent of total billed charges,40% of total billed charges,109.01,234,
MORPHINE 50MG/ML,6065130,CDM,636,RC,J2270,HCPCS,Outpatient,,,6562.05,5249.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5249.64,80,,4199.71,percent of total billed charges,80% of total billed charges,2445.68,37.27,,1956.54,percent of total billed charges,37.27% of total billed charges,2445.68,37.27,,1956.54,percent of total billed charges,37.27% of total billed charges,2445.68,37.27,,1956.54,percent of total billed charges,37.27% 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,2624.82,40,,2099.86,percent of total billed charges,40% of total billed charges,2445.68,5249.64,
TRANEXAMIC ACID,6400014,CDM,250,RC,,,Outpatient,,,3.7,2.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.96,80,,2.37,percent of total billed charges,80% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% of total billed charges,1.38,37.27,,1.1,percent of total billed charges,37.27% 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,1.48,40,,1.18,percent of total billed charges,40% of total billed charges,1.38,2.96,
IEPU+INT RANDOM URIN,7000029,CDM,301,RC,,,Outpatient,,,377,301.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,301.6,80,,241.28,percent of total billed charges,80% of total billed charges,140.51,37.27,,112.41,percent of total billed charges,37.27% of total billed charges,140.51,37.27,,112.41,percent of total billed charges,37.27% of total billed charges,140.51,37.27,,112.41,percent of total billed charges,37.27% 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,150.8,40,,120.64,percent of total billed charges,40% of total billed charges,140.51,301.6,
ADSORPTION-PER ADSOR,7000169,CDM,302,RC,86978,HCPCS,Outpatient,,,44.45,35.56,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.56,80,,28.45,percent of total billed charges,80% of total billed charges,16.57,37.27,,13.26,percent of total billed charges,37.27% of total billed charges,16.57,37.27,,13.26,percent of total billed charges,37.27% of total billed charges,16.57,37.27,,13.26,percent of total billed charges,37.27% of total billed charges,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.78,40,,14.22,percent of total billed charges,40% of total billed charges,16.57,50.43,
SHUNT SERIES,6000392,CDM,320,RC,75809,HCPCS,Outpatient,,,260,208.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208,80,,166.4,percent of total billed charges,80% of total billed charges,96.9,37.27,,77.52,percent of total billed charges,37.27% of total billed charges,96.9,37.27,,77.52,percent of total billed charges,37.27% of total billed charges,96.9,37.27,,77.52,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,75.39,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104,40,,83.2,percent of total billed charges,40% of total billed charges,75.39,208,
DEPO MEDROL 80MG INJ,6400014,CDM,250,RC,,,Outpatient,,,80.7,64.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.56,80,,51.65,percent of total billed charges,80% of total billed charges,30.08,37.27,,24.06,percent of total billed charges,37.27% of total billed charges,30.08,37.27,,24.06,percent of total billed charges,37.27% of total billed charges,30.08,37.27,,24.06,percent of total billed charges,37.27% 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,32.28,40,,25.82,percent of total billed charges,40% of total billed charges,30.08,64.56,
DEPO-MEDROL 80MG/ML,6065130,CDM,636,RC,J1040,HCPCS,Outpatient,,,56.9,45.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.52,80,,36.42,percent of total billed charges,80% of total billed charges,21.21,37.27,,16.97,percent of total billed charges,37.27% of total billed charges,21.21,37.27,,16.97,percent of total billed charges,37.27% of total billed charges,21.21,37.27,,16.97,percent of total billed charges,37.27% 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,22.76,40,,18.21,percent of total billed charges,40% of total billed charges,21.21,45.52,
FEBRILE ANTIBODY PAN,7012032,CDM,300,RC,,,Outpatient,,,391.44,313.15,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,313.15,80,,250.52,percent of total billed charges,80% of total billed charges,145.89,37.27,,116.71,percent of total billed charges,37.27% of total billed charges,145.89,37.27,,116.71,percent of total billed charges,37.27% of total billed charges,145.89,37.27,,116.71,percent of total billed charges,37.27% 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,156.58,40,,125.26,percent of total billed charges,40% of total billed charges,145.89,313.15,
HH (PANEL),7000177,CDM,305,RC,,,Outpatient,,,25.31,20.25,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.25,80,,16.2,percent of total billed charges,80% of total billed charges,9.43,37.27,,7.54,percent of total billed charges,37.27% of total billed charges,9.43,37.27,,7.54,percent of total billed charges,37.27% of total billed charges,9.43,37.27,,7.54,percent of total billed charges,37.27% 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,10.12,40,,8.1,percent of total billed charges,40% of total billed charges,9.43,20.25,
VANCOMYCIN ORAL SOL,6400014,CDM,250,RC,,,Outpatient,,,2.95,2.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.36,80,,1.89,percent of total billed charges,80% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% of total billed charges,1.1,37.27,,0.88,percent of total billed charges,37.27% 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,1.18,40,,0.94,percent of total billed charges,40% of total billed charges,1.1,2.36,
ELIQUIS 2.5MG,5880901,CDM,637,RC,,,Outpatient,,,40.5,32.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.4,80,,25.92,percent of total billed charges,80% of total billed charges,15.09,37.27,,12.07,percent of total billed charges,37.27% of total billed charges,15.09,37.27,,12.07,percent of total billed charges,37.27% of total billed charges,15.09,37.27,,12.07,percent of total billed charges,37.27% 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,16.2,40,,12.96,percent of total billed charges,40% of total billed charges,15.09,32.4,
FOOD ALLERGIES IGE,7000177,CDM,305,RC,,,Outpatient,,,298.68,238.94,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,238.94,80,,191.15,percent of total billed charges,80% of total billed charges,111.32,37.27,,89.06,percent of total billed charges,37.27% of total billed charges,111.32,37.27,,89.06,percent of total billed charges,37.27% of total billed charges,111.32,37.27,,89.06,percent of total billed charges,37.27% 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,119.47,40,,95.58,percent of total billed charges,40% of total billed charges,111.32,238.94,
VENOFER 20MG/ML INJ,6065130,CDM,636,RC,J1756,HCPCS,Outpatient,,,250.5,200.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.4,80,,160.32,percent of total billed charges,80% of total billed charges,93.36,37.27,,74.69,percent of total billed charges,37.27% of total billed charges,93.36,37.27,,74.69,percent of total billed charges,37.27% of total billed charges,93.36,37.27,,74.69,percent of total billed charges,37.27% 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,100.2,40,,80.16,percent of total billed charges,40% of total billed charges,93.36,200.4,
DRESSING HEEL FOAM,5801832,CDM,272,RC,,,Outpatient,,,32.73,26.18,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.18,80,,20.94,percent of total billed charges,80% of total billed charges,12.2,37.27,,9.76,percent of total billed charges,37.27% of total billed charges,12.2,37.27,,9.76,percent of total billed charges,37.27% of total billed charges,12.2,37.27,,9.76,percent of total billed charges,37.27% 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,13.09,40,,10.47,percent of total billed charges,40% of total billed charges,12.2,26.18,
ANTIEPILEPTICS NOS,7000169,CDM,302,RC,80339,HCPCS,Outpatient,,,28.53,22.82,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.82,80,,18.26,percent of total billed charges,80% of total billed charges,10.63,37.27,,8.5,percent of total billed charges,37.27% of total billed charges,10.63,37.27,,8.5,percent of total billed charges,37.27% of total billed charges,10.63,37.27,,8.5,percent of total billed charges,37.27% 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,11.41,40,,9.13,percent of total billed charges,40% of total billed charges,10.63,22.82,
DRUGS OR SUBSTANCES,7000029,CDM,301,RC,80375,HCPCS,Outpatient,,,411.78,329.42,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,329.42,80,,263.54,percent of total billed charges,80% of total billed charges,153.47,37.27,,122.78,percent of total billed charges,37.27% of total billed charges,153.47,37.27,,122.78,percent of total billed charges,37.27% of total billed charges,153.47,37.27,,122.78,percent of total billed charges,37.27% 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,164.71,40,,131.77,percent of total billed charges,40% of total billed charges,153.47,329.42,
MRI ANKLE WO CONT,6212047,CDM,610,RC,73721,HCPCS,Outpatient,,,3016,2412.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,183.76,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,183.76,2412.8,
RIB RT 2VWS,6000392,CDM,320,RC,71100,HCPCS,Outpatient,,,263,210.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,80,,168.32,percent of total billed charges,80% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,98.02,37.27,,78.42,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,33.52,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,105.2,40,,84.16,percent of total billed charges,40% of total billed charges,33.52,210.4,
CT HEAD W,6010003,CDM,351,RC,70460,HCPCS,Outpatient,,,2124,1699.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1699.2,80,,1359.36,percent of total billed charges,80% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,791.61,37.27,,633.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,125.7,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,849.6,40,,679.68,percent of total billed charges,40% of total billed charges,125.7,1699.2,
PROVAYBLUE,6065130,CDM,636,RC,,,Outpatient,,,940.65,752.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,752.52,80,,602.02,percent of total billed charges,80% of total billed charges,350.58,37.27,,280.46,percent of total billed charges,37.27% of total billed charges,350.58,37.27,,280.46,percent of total billed charges,37.27% of total billed charges,350.58,37.27,,280.46,percent of total billed charges,37.27% 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,376.26,40,,301.01,percent of total billed charges,40% of total billed charges,350.58,752.52,
CNTRL LINE KIT 7FR,5801832,CDM,272,RC,,,Outpatient,,,406.08,324.86,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,324.86,80,,259.89,percent of total billed charges,80% of total billed charges,151.35,37.27,,121.08,percent of total billed charges,37.27% of total billed charges,151.35,37.27,,121.08,percent of total billed charges,37.27% of total billed charges,151.35,37.27,,121.08,percent of total billed charges,37.27% 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,162.43,40,,129.94,percent of total billed charges,40% of total billed charges,151.35,324.86,
NOVOLOG INSULIN,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,154.75,123.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,123.8,80,,99.04,percent of total billed charges,80% of total billed charges,57.68,37.27,,46.14,percent of total billed charges,37.27% of total billed charges,57.68,37.27,,46.14,percent of total billed charges,37.27% of total billed charges,57.68,37.27,,46.14,percent of total billed charges,37.27% 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,61.9,40,,49.52,percent of total billed charges,40% of total billed charges,57.68,123.8,
DIFLUCAN INJ,6400014,CDM,250,RC,,,Outpatient,,,38.95,31.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.16,80,,24.93,percent of total billed charges,80% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% of total billed charges,14.52,37.27,,11.62,percent of total billed charges,37.27% 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,15.58,40,,12.46,percent of total billed charges,40% of total billed charges,14.52,31.16,
JARDIANCE,6400014,CDM,250,RC,,,Outpatient,,,83.35,66.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.68,80,,53.34,percent of total billed charges,80% of total billed charges,31.06,37.27,,24.85,percent of total billed charges,37.27% of total billed charges,31.06,37.27,,24.85,percent of total billed charges,37.27% of total billed charges,31.06,37.27,,24.85,percent of total billed charges,37.27% 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,33.34,40,,26.67,percent of total billed charges,40% of total billed charges,31.06,66.68,
CARIMUNE,6065130,CDM,636,RC,,,Outpatient,,,230.4,184.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,184.32,80,,147.46,percent of total billed charges,80% of total billed charges,85.87,37.27,,68.7,percent of total billed charges,37.27% of total billed charges,85.87,37.27,,68.7,percent of total billed charges,37.27% of total billed charges,85.87,37.27,,68.7,percent of total billed charges,37.27% 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,92.16,40,,73.73,percent of total billed charges,40% of total billed charges,85.87,184.32,
CONT INH TRT EA ADDL,7439094,CDM,410,RC,94645,HCPCS,Outpatient,,,96,76.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.84,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,40,,30.72,percent of total billed charges,40% of total billed charges,20.84,76.8,
VAC/TOXOID ADM 1ST,9397936,CDM,771,RC,90471,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,27.36,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64,40,,51.2,percent of total billed charges,40% of total billed charges,27.36,128,
INTUBATION,5612346,CDM,761,RC,SURG,HCPCS,Outpatient,,,646,516.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% 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,258.4,40,,206.72,percent of total billed charges,40% of total billed charges,240.76,516.8,
CORLANOR 5MG TAB,5880901,CDM,637,RC,,,Outpatient,,,40.65,32.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.52,80,,26.02,percent of total billed charges,80% of total billed charges,15.15,37.27,,12.12,percent of total billed charges,37.27% of total billed charges,15.15,37.27,,12.12,percent of total billed charges,37.27% of total billed charges,15.15,37.27,,12.12,percent of total billed charges,37.27% 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,16.26,40,,13.01,percent of total billed charges,40% of total billed charges,15.15,32.52,
DILAUDID 0.5MG INJ,6065130,CDM,636,RC,J1170,HCPCS,Outpatient,,,28.2,22.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.56,80,,18.05,percent of total billed charges,80% of total billed charges,10.51,37.27,,8.41,percent of total billed charges,37.27% of total billed charges,10.51,37.27,,8.41,percent of total billed charges,37.27% of total billed charges,10.51,37.27,,8.41,percent of total billed charges,37.27% 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,11.28,40,,9.02,percent of total billed charges,40% of total billed charges,10.51,22.56,
ENCEPHALITS AR PANEL,7000169,CDM,302,RC,,,Outpatient,,,725.1,580.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,580.08,80,,464.06,percent of total billed charges,80% of total billed charges,270.24,37.27,,216.19,percent of total billed charges,37.27% of total billed charges,270.24,37.27,,216.19,percent of total billed charges,37.27% of total billed charges,270.24,37.27,,216.19,percent of total billed charges,37.27% 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,290.04,40,,232.03,percent of total billed charges,40% of total billed charges,270.24,580.08,
TELEMETRY-MED SURG,22004,CDM,206,RC,,,Inpatient,,,1297,1037.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1037.6,80,,830.08,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,1037.6,1037.6,
BACTERIAL AG PANEL,7012032,CDM,300,RC,,,Outpatient,,,173.16,138.53,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.53,80,,110.82,percent of total billed charges,80% of total billed charges,64.54,37.27,,51.63,percent of total billed charges,37.27% of total billed charges,64.54,37.27,,51.63,percent of total billed charges,37.27% of total billed charges,64.54,37.27,,51.63,percent of total billed charges,37.27% 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,69.26,40,,55.41,percent of total billed charges,40% of total billed charges,64.54,138.53,
TERCONAZOLE 0.8% CR,6400014,CDM,250,RC,,,Outpatient,,,119.1,95.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.28,80,,76.22,percent of total billed charges,80% of total billed charges,44.39,37.27,,35.51,percent of total billed charges,37.27% of total billed charges,44.39,37.27,,35.51,percent of total billed charges,37.27% of total billed charges,44.39,37.27,,35.51,percent of total billed charges,37.27% 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,47.64,40,,38.11,percent of total billed charges,40% of total billed charges,44.39,95.28,
ENDO LIGACLIP ROTATE,5801832,CDM,272,RC,,,Outpatient,,,180.7,144.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144.56,80,,115.65,percent of total billed charges,80% of total billed charges,67.35,37.27,,53.88,percent of total billed charges,37.27% of total billed charges,67.35,37.27,,53.88,percent of total billed charges,37.27% of total billed charges,67.35,37.27,,53.88,percent of total billed charges,37.27% 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,72.28,40,,57.82,percent of total billed charges,40% of total billed charges,67.35,144.56,
MOVANTIK 25MG,6400014,CDM,250,RC,,,Outpatient,,,50.35,40.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.28,80,,32.22,percent of total billed charges,80% of total billed charges,18.77,37.27,,15.02,percent of total billed charges,37.27% of total billed charges,18.77,37.27,,15.02,percent of total billed charges,37.27% of total billed charges,18.77,37.27,,15.02,percent of total billed charges,37.27% 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,20.14,40,,16.11,percent of total billed charges,40% of total billed charges,18.77,40.28,
ER CARE LEVEL 1,8830002,CDM,450,RC,99281,HCPCS,Outpatient,,,224,179.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.2,80,,143.36,percent of total billed charges,80% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% of total billed charges,83.48,37.27,,66.78,percent of total billed charges,37.27% of total billed charges,673.2,100,,,case rate ,pays based on per visit rate,673.2,100,,,fee schedule,100% of APC rate,673.2,100,,,fee schedule,100% of APC rate,600,145,,,fee schedule,145% of CMS fee schedule,673.2,100,,,fee schedule,100% of APC rate,673.2,100,,,fee schedule,100% of APC rate,673.2,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,89.6,40,,71.68,percent of total billed charges,40% of total billed charges,83.48,673.2,
ER CARE LEVEL 2,8830002,CDM,450,RC,99282,HCPCS,Outpatient,,,365,292.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,292,80,,233.6,percent of total billed charges,80% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% of total billed charges,734.85,100,,,case rate ,pays based on per visit rate,734.85,100,,,fee schedule,100% of APC rate,734.85,100,,,fee schedule,100% of APC rate,600,145,,,fee schedule,145% of CMS fee schedule,734.85,100,,,fee schedule,100% of APC rate,734.85,100,,,fee schedule,100% of APC rate,734.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146,40,,116.8,percent of total billed charges,40% of total billed charges,136.04,734.85,
ER CARE LEVEL 3,8830002,CDM,450,RC,99283,HCPCS,Outpatient,,,590,472.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472,80,,377.6,percent of total billed charges,80% of total billed charges,219.89,37.27,,175.91,percent of total billed charges,37.27% of total billed charges,219.89,37.27,,175.91,percent of total billed charges,37.27% of total billed charges,219.89,37.27,,175.91,percent of total billed charges,37.27% of total billed charges,835.24,100,,,case rate ,pays based on per visit rate,835.24,100,,,fee schedule,100% of APC rate,835.24,100,,,fee schedule,100% of APC rate,600,145,,,fee schedule,145% of CMS fee schedule,835.24,100,,,fee schedule,100% of APC rate,835.24,100,,,fee schedule,100% of APC rate,835.24,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,236,40,,188.8,percent of total billed charges,40% of total billed charges,219.89,835.24,
ER CARE LEVEL 4,8830002,CDM,450,RC,99284,HCPCS,Outpatient,,,785,628.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,628,80,,502.4,percent of total billed charges,80% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,292.57,37.27,,234.06,percent of total billed charges,37.27% of total billed charges,965.18,100,,,case rate ,pays based on per visit rate,965.18,100,,,fee schedule,100% of APC rate,965.18,100,,,fee schedule,100% of APC rate,600,145,,,fee schedule,145% of CMS fee schedule,965.18,100,,,fee schedule,100% of APC rate,965.18,100,,,fee schedule,100% of APC rate,965.18,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,314,40,,251.2,percent of total billed charges,40% of total billed charges,292.57,965.18,
ER CARE LEVEL 5,8830002,CDM,450,RC,99285,HCPCS,Outpatient,,,1122,897.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,897.6,80,,718.08,percent of total billed charges,80% of total billed charges,418.17,37.27,,334.54,percent of total billed charges,37.27% of total billed charges,418.17,37.27,,334.54,percent of total billed charges,37.27% of total billed charges,418.17,37.27,,334.54,percent of total billed charges,37.27% of total billed charges,1129.59,100,,,case rate ,pays based on per visit rate,1129.59,100,,,fee schedule,100% of APC rate,1129.59,100,,,fee schedule,100% of APC rate,600,145,,,fee schedule,145% of CMS fee schedule,1129.59,100,,,fee schedule,100% of APC rate,1129.59,100,,,fee schedule,100% of APC rate,1129.59,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,448.8,40,,359.04,percent of total billed charges,40% of total billed charges,418.17,1129.59,
CRIT CARE 30-74M W/P,8830002,CDM,450,RC,99291,HCPCS,Outpatient,,,1889,1511.20,25,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1511.2,80,,1208.96,percent of total billed charges,80% of total billed charges,704.03,37.27,,563.22,percent of total billed charges,37.27% of total billed charges,704.03,37.27,,563.22,percent of total billed charges,37.27% of total billed charges,704.03,37.27,,563.22,percent of total billed charges,37.27% of total billed charges,1331.64,100,,,case rate ,pays based on per visit rate,1331.64,100,,,fee schedule,100% of APC rate,1331.64,100,,,fee schedule,100% of APC rate,600,145,,,fee schedule,145% of CMS fee schedule,1331.64,100,,,fee schedule,100% of APC rate,1331.64,100,,,fee schedule,100% of APC rate,1331.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,755.6,40,,604.48,percent of total billed charges,40% of total billed charges,600,1511.2,
CRIT CARE EA ADDL 30,8830002,CDM,450,RC,99292,HCPCS,Outpatient,,,850,680.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,680,80,,544,percent of total billed charges,80% of total billed charges,316.8,37.27,,253.44,percent of total billed charges,37.27% of total billed charges,316.8,37.27,,253.44,percent of total billed charges,37.27% of total billed charges,316.8,37.27,,253.44,percent of total billed charges,37.27% of total billed charges,600,100,,,case rate ,pays based on per visit rate,600,100,,,case rate ,pays based on per visit rate,600,100,,,case rate ,pays based on per visit rate,600,145,,,fee schedule,145% of CMS fee schedule,600,100,,,case rate,pays based on per visit rate,600,100,,,case rate,pays based on per visit rate,600,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,340,40,,272,percent of total billed charges,40% of total billed charges,316.8,680,
PULSE OX MULTI ER,7441215,CDM,460,RC,94761,HCPCS,Outpatient,,,149,119.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.19,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.6,40,,47.68,percent of total billed charges,40% of total billed charges,5.19,119.2,
OXYCODONE,6400014,CDM,250,RC,,,Outpatient,,,2.7,2.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.16,80,,1.73,percent of total billed charges,80% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% of total billed charges,1.01,37.27,,0.81,percent of total billed charges,37.27% 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,1.08,40,,0.86,percent of total billed charges,40% of total billed charges,1.01,2.16,
MOR VENT TUBE 1.27MM,5645742,CDM,270,RC,,,Outpatient,,,196,156.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% 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,78.4,40,,62.72,percent of total billed charges,40% of total billed charges,73.05,156.8,
DEPUY FEMORAL HEAD,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2029.95,1623.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1623.96,80,,1299.17,percent of total billed charges,80% of total billed charges,756.56,37.27,,605.25,percent of total billed charges,37.27% of total billed charges,756.56,37.27,,605.25,percent of total billed charges,37.27% of total billed charges,756.56,37.27,,605.25,percent of total billed charges,37.27% 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,811.98,40,,649.58,percent of total billed charges,40% of total billed charges,756.56,1623.96,
DEPUY STEM CNTR 10.5,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,327.6,262.08,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.08,80,,209.66,percent of total billed charges,80% of total billed charges,122.1,37.27,,97.68,percent of total billed charges,37.27% of total billed charges,122.1,37.27,,97.68,percent of total billed charges,37.27% of total billed charges,122.1,37.27,,97.68,percent of total billed charges,37.27% 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,131.04,40,,104.83,percent of total billed charges,40% of total billed charges,122.1,262.08,
FEMORAL STEM SZ 6,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,9354.15,7483.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7483.32,80,,5986.66,percent of total billed charges,80% of total billed charges,3486.29,37.27,,2789.03,percent of total billed charges,37.27% of total billed charges,3486.29,37.27,,2789.03,percent of total billed charges,37.27% of total billed charges,3486.29,37.27,,2789.03,percent of total billed charges,37.27% 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,3741.66,40,,2993.33,percent of total billed charges,40% of total billed charges,3486.29,7483.32,
BIPOLAR HEAD 28X44,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4617.5,3694.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3694,80,,2955.2,percent of total billed charges,80% of total billed charges,1720.94,37.27,,1376.75,percent of total billed charges,37.27% of total billed charges,1720.94,37.27,,1376.75,percent of total billed charges,37.27% of total billed charges,1720.94,37.27,,1376.75,percent of total billed charges,37.27% 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,1847,40,,1477.6,percent of total billed charges,40% of total billed charges,1720.94,3694,
BONE CEMENT,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,411.78,329.42,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,329.42,80,,263.54,percent of total billed charges,80% of total billed charges,153.47,37.27,,122.78,percent of total billed charges,37.27% of total billed charges,153.47,37.27,,122.78,percent of total billed charges,37.27% of total billed charges,153.47,37.27,,122.78,percent of total billed charges,37.27% 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,164.71,40,,131.77,percent of total billed charges,40% of total billed charges,153.47,329.42,
CEMENT MIXER,5645742,CDM,270,RC,,,Outpatient,,,765,612.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,612,80,,489.6,percent of total billed charges,80% of total billed charges,285.12,37.27,,228.1,percent of total billed charges,37.27% of total billed charges,285.12,37.27,,228.1,percent of total billed charges,37.27% of total billed charges,285.12,37.27,,228.1,percent of total billed charges,37.27% 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,306,40,,244.8,percent of total billed charges,40% of total billed charges,285.12,612,
PREP KIT,5645742,CDM,270,RC,,,Outpatient,,,972.5,778.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,778,80,,622.4,percent of total billed charges,80% of total billed charges,362.45,37.27,,289.96,percent of total billed charges,37.27% of total billed charges,362.45,37.27,,289.96,percent of total billed charges,37.27% of total billed charges,362.45,37.27,,289.96,percent of total billed charges,37.27% 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,389,40,,311.2,percent of total billed charges,40% of total billed charges,362.45,778,
LISINOPRIL 2.5MG,5880901,CDM,637,RC,,,Outpatient,,,2.3,1.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.84,80,,1.47,percent of total billed charges,80% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% of total billed charges,0.86,37.27,,0.69,percent of total billed charges,37.27% 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,0.92,40,,0.74,percent of total billed charges,40% of total billed charges,0.86,1.84,
ARIPIPRAZOLE 5MG,6400014,CDM,250,RC,,,Outpatient,,,99.55,79.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.64,80,,63.71,percent of total billed charges,80% of total billed charges,37.1,37.27,,29.68,percent of total billed charges,37.27% of total billed charges,37.1,37.27,,29.68,percent of total billed charges,37.27% of total billed charges,37.1,37.27,,29.68,percent of total billed charges,37.27% 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,39.82,40,,31.86,percent of total billed charges,40% of total billed charges,37.1,79.64,
BENZTROPINE INJ 2MG,6065130,CDM,636,RC,J0515,HCPCS,Outpatient,,,255.75,204.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,204.6,80,,163.68,percent of total billed charges,80% of total billed charges,95.32,37.27,,76.26,percent of total billed charges,37.27% of total billed charges,95.32,37.27,,76.26,percent of total billed charges,37.27% of total billed charges,95.32,37.27,,76.26,percent of total billed charges,37.27% 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,102.3,40,,81.84,percent of total billed charges,40% of total billed charges,95.32,204.6,
INVEGA 3MG,6065130,CDM,636,RC,J2426,HCPCS,Outpatient,,,128.45,102.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,102.76,80,,82.21,percent of total billed charges,80% of total billed charges,47.87,37.27,,38.3,percent of total billed charges,37.27% of total billed charges,47.87,37.27,,38.3,percent of total billed charges,37.27% of total billed charges,47.87,37.27,,38.3,percent of total billed charges,37.27% of total billed charges,14.76,100,,,fee schedule,100% of APC rate,14.76,100,,,fee schedule,100% of APC rate,14.76,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,14.76,100,,,fee schedule,100% of APC rate,14.76,100,,,fee schedule,100% of APC rate,14.76,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.38,40,,41.1,percent of total billed charges,40% of total billed charges,14.76,102.76,
INVEGA INJ,6065130,CDM,636,RC,J2426,HCPCS,Outpatient,,,9601.2,7680.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7680.96,80,,6144.77,percent of total billed charges,80% of total billed charges,3578.37,37.27,,2862.7,percent of total billed charges,37.27% of total billed charges,3578.37,37.27,,2862.7,percent of total billed charges,37.27% of total billed charges,3578.37,37.27,,2862.7,percent of total billed charges,37.27% of total billed charges,14.76,100,,,fee schedule,100% of APC rate,14.76,100,,,fee schedule,100% of APC rate,14.76,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,14.76,100,,,fee schedule,100% of APC rate,14.76,100,,,fee schedule,100% of APC rate,14.76,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3840.48,40,,3072.38,percent of total billed charges,40% of total billed charges,14.76,7680.96,
RESECTION GUIDE SET,5645742,CDM,270,RC,,,Outpatient,,,2000,1600.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1600,80,,1280,percent of total billed charges,80% of total billed charges,745.4,37.27,,596.32,percent of total billed charges,37.27% of total billed charges,745.4,37.27,,596.32,percent of total billed charges,37.27% of total billed charges,745.4,37.27,,596.32,percent of total billed charges,37.27% 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,800,40,,640,percent of total billed charges,40% of total billed charges,745.4,1600,
DEPUY PATELLA DOME,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2087,1669.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1669.6,80,,1335.68,percent of total billed charges,80% of total billed charges,777.82,37.27,,622.26,percent of total billed charges,37.27% of total billed charges,777.82,37.27,,622.26,percent of total billed charges,37.27% of total billed charges,777.82,37.27,,622.26,percent of total billed charges,37.27% 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,834.8,40,,667.84,percent of total billed charges,40% of total billed charges,777.82,1669.6,
DEPUY TIBIAL INSERT,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4804,3843.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3843.2,80,,3074.56,percent of total billed charges,80% of total billed charges,1790.45,37.27,,1432.36,percent of total billed charges,37.27% of total billed charges,1790.45,37.27,,1432.36,percent of total billed charges,37.27% of total billed charges,1790.45,37.27,,1432.36,percent of total billed charges,37.27% 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,1921.6,40,,1537.28,percent of total billed charges,40% of total billed charges,1790.45,3843.2,
DEPUY SCREW ALL SIZE,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,532,425.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% 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,212.8,40,,170.24,percent of total billed charges,40% of total billed charges,198.28,425.6,
DEPUY TIBIAL BEARING,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,7150,5720.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5720,80,,4576,percent of total billed charges,80% of total billed charges,2664.81,37.27,,2131.85,percent of total billed charges,37.27% of total billed charges,2664.81,37.27,,2131.85,percent of total billed charges,37.27% of total billed charges,2664.81,37.27,,2131.85,percent of total billed charges,37.27% 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,2860,40,,2288,percent of total billed charges,40% of total billed charges,2664.81,5720,
DEPUY FEMORAL 2.5 RT,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,8377,6701.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6701.6,80,,5361.28,percent of total billed charges,80% of total billed charges,3122.11,37.27,,2497.69,percent of total billed charges,37.27% of total billed charges,3122.11,37.27,,2497.69,percent of total billed charges,37.27% of total billed charges,3122.11,37.27,,2497.69,percent of total billed charges,37.27% 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,3350.8,40,,2680.64,percent of total billed charges,40% of total billed charges,3122.11,6701.6,
STENT BARDX DBL PGTL,8605396,CDM,278,RC,C2617,HCPCS,Outpatient,,,125,100.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100,80,,80,percent of total billed charges,80% of total billed charges,46.59,37.27,,37.27,percent of total billed charges,37.27% of total billed charges,46.59,37.27,,37.27,percent of total billed charges,37.27% of total billed charges,46.59,37.27,,37.27,percent of total billed charges,37.27% 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,50,40,,40,percent of total billed charges,40% of total billed charges,46.59,100,
STENT 6X22,8605396,CDM,278,RC,C2617,HCPCS,Outpatient,,,368,294.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% 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,147.2,40,,117.76,percent of total billed charges,40% of total billed charges,137.15,294.4,
STENT 6X24,8605396,CDM,278,RC,C2617,HCPCS,Outpatient,,,368,294.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% 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,147.2,40,,117.76,percent of total billed charges,40% of total billed charges,137.15,294.4,
STENT 6X26,8605396,CDM,278,RC,C2617,HCPCS,Outpatient,,,368,294.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% 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,147.2,40,,117.76,percent of total billed charges,40% of total billed charges,137.15,294.4,
STENT 6X28,8605396,CDM,278,RC,C2617,HCPCS,Outpatient,,,368,294.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% 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,147.2,40,,117.76,percent of total billed charges,40% of total billed charges,137.15,294.4,
STENT 7X24,8605396,CDM,278,RC,C2617,HCPCS,Outpatient,,,368,294.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% 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,147.2,40,,117.76,percent of total billed charges,40% of total billed charges,137.15,294.4,
STENT 7X26,8605396,CDM,278,RC,C2617,HCPCS,Outpatient,,,368,294.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% 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,147.2,40,,117.76,percent of total billed charges,40% of total billed charges,137.15,294.4,
STENT 7X28,8605396,CDM,278,RC,C2617,HCPCS,Outpatient,,,368,294.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,294.4,80,,235.52,percent of total billed charges,80% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% of total billed charges,137.15,37.27,,109.72,percent of total billed charges,37.27% 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,147.2,40,,117.76,percent of total billed charges,40% of total billed charges,137.15,294.4,
CATH UR FLEX TIP OE,5801832,CDM,272,RC,,,Outpatient,,,119,95.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.2,80,,76.16,percent of total billed charges,80% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% of total billed charges,44.35,37.27,,35.48,percent of total billed charges,37.27% 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,47.6,40,,38.08,percent of total billed charges,40% of total billed charges,44.35,95.2,
GUIDEWIRE STRAI FLEX,5801832,CDM,272,RC,,,Outpatient,,,109,87.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.2,80,,69.76,percent of total billed charges,80% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% of total billed charges,40.62,37.27,,32.5,percent of total billed charges,37.27% 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,43.6,40,,34.88,percent of total billed charges,40% of total billed charges,40.62,87.2,
GUDEWRE PTFE L150CM,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
BALN DIL CAT 15X10X5,5801832,CDM,272,RC,,,Outpatient,,,796,636.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,636.8,80,,509.44,percent of total billed charges,80% of total billed charges,296.67,37.27,,237.34,percent of total billed charges,37.27% of total billed charges,296.67,37.27,,237.34,percent of total billed charges,37.27% of total billed charges,296.67,37.27,,237.34,percent of total billed charges,37.27% 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,318.4,40,,254.72,percent of total billed charges,40% of total billed charges,296.67,636.8,
BALL DIL CATH 15X4X5,5801832,CDM,272,RC,,,Outpatient,,,796,636.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,636.8,80,,509.44,percent of total billed charges,80% of total billed charges,296.67,37.27,,237.34,percent of total billed charges,37.27% of total billed charges,296.67,37.27,,237.34,percent of total billed charges,37.27% of total billed charges,296.67,37.27,,237.34,percent of total billed charges,37.27% 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,318.4,40,,254.72,percent of total billed charges,40% of total billed charges,296.67,636.8,
SOLYX MID URTH SLING,8605396,CDM,278,RC,C1771,HCPCS,Outpatient,,,3125,2500.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2500,80,,2000,percent of total billed charges,80% of total billed charges,1164.69,37.27,,931.75,percent of total billed charges,37.27% of total billed charges,1164.69,37.27,,931.75,percent of total billed charges,37.27% of total billed charges,1164.69,37.27,,931.75,percent of total billed charges,37.27% 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,1250,40,,1000,percent of total billed charges,40% of total billed charges,1164.69,2500,
STONE BASKETS 0-TIP,5801832,CDM,272,RC,,,Outpatient,,,591,472.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472.8,80,,378.24,percent of total billed charges,80% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% 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,236.4,40,,189.12,percent of total billed charges,40% of total billed charges,220.27,472.8,
ELIC CLOT EVAL UROVA,5801832,CDM,272,RC,,,Outpatient,,,56,44.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.8,80,,35.84,percent of total billed charges,80% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% of total billed charges,20.87,37.27,,16.7,percent of total billed charges,37.27% 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,22.4,40,,17.92,percent of total billed charges,40% of total billed charges,20.87,44.8,
URETH ACCESS SHEATHS,5801832,CDM,272,RC,,,Outpatient,,,445,356.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,356,80,,284.8,percent of total billed charges,80% of total billed charges,165.85,37.27,,132.68,percent of total billed charges,37.27% of total billed charges,165.85,37.27,,132.68,percent of total billed charges,37.27% of total billed charges,165.85,37.27,,132.68,percent of total billed charges,37.27% 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,178,40,,142.4,percent of total billed charges,40% of total billed charges,165.85,356,
CATH 2WAY 18 FR 5CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
SEROQUEL 100MG,6400014,CDM,250,RC,,,Outpatient,,,1.9,1.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.52,80,,1.22,percent of total billed charges,80% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% of total billed charges,0.71,37.27,,0.57,percent of total billed charges,37.27% 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,0.76,40,,0.61,percent of total billed charges,40% of total billed charges,0.71,1.52,
CATH 2WAY 20 FR 5CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
CATH 2WAY 22 FR 5CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
CATH 2WAY 14FR 30CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
CATH 2WAY 16FR 30CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
CATH 2WAY 18 FR 30CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
CATH 2WAY 20FR 30CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
CATH 2WAY 22FR 30CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
CATH 2WAY 24FR 30CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
CATH CRSN 2WAY 14FR,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
CARSON COUDE 2WY 16F,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
CARSON COUDE 2WY 20F,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
CARSON COUDE 2WY 20F,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
CARSON COUDE 2WY 22F,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
CARSON COUDE 2WY 24F,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
TIEMAN COUDE 2WY 16F,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
TIEMAN COUDE 2WY 18F,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
TIEMAN COUDE 2WY 20F,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
TIEMAN COUDE 2WY 22F,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
3WAY 16FR 5CC CATH,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
3WAY 18 FR 5CC CATH,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
3WAY 20FR CATH 5CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
3WAY 22FR 5CC CATH,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
3WAY 24FR 5CC CATH,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
3WAY 16FR 30CC CATH,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
3WAY 18FR 30CC CATH,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
3WAY 20FR 30CC CATH,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
3WAY 22FR 30CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
3WAY 24FR 30CC CATH,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
COUVE CDE 18FR 30CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
HEY FILI OLIV TIP 4F,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
HEY FILI SPIR TIP 4F,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
TIEMAN CDE RR 16FR,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
TIEMAN CDE RR 18FR,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
LUMBRISIL 2WY 16FR,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
LUBRISIL 2WAY 18FR,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
LUBRISIL 2WAY 20FR,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
LUBRISIL 2WAY 22FR,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
LUBRI 3WY 16FR 30CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
LUB 3WAY 18 FR 30CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
LUB 3WAY 20FR 30CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
LUB 3WAY 22FR 30CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
LUB 3WAY 16FR 5CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
LUB 3WAY 18 FR 5CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
LUB 3WAY 20FR 5CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
LUB 3WAY 22FR 5CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
URO HYMN 123400 TRAY,5801832,CDM,272,RC,,,Outpatient,,,347,277.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% 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,138.8,40,,111.04,percent of total billed charges,40% of total billed charges,129.33,277.6,
SUPRPUB 143112 TRAY,5801832,CDM,272,RC,,,Outpatient,,,143,114.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% 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,57.2,40,,45.76,percent of total billed charges,40% of total billed charges,53.3,114.4,
COUNCL 2WY 16FR 5CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
COUNCL 2WY 18 FR 5CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
CONCIL 2WY 20 FR 5CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
COUNCIL 2WY 22FR 5CC,5801832,CDM,272,RC,,,Outpatient,,,50,40.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% 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,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
ZYPREXA 10MG I.M.,6065130,CDM,636,RC,J2359,HCPCS,Outpatient,,,193.95,155.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,155.16,80,,124.13,percent of total billed charges,80% of total billed charges,72.29,37.27,,57.83,percent of total billed charges,37.27% of total billed charges,72.29,37.27,,57.83,percent of total billed charges,37.27% of total billed charges,72.29,37.27,,57.83,percent of total billed charges,37.27% of total billed charges,0.92,100,,,fee schedule,100% of APC rate,0.92,100,,,fee schedule,100% of APC rate,0.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.92,100,,,fee schedule,100% of APC rate,0.92,100,,,fee schedule,100% of APC rate,0.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,77.58,40,,62.06,percent of total billed charges,40% of total billed charges,0.92,155.16,
JANUMET XR 100/1000,5880901,CDM,637,RC,,,Outpatient,,,78.15,62.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,62.52,80,,50.02,percent of total billed charges,80% of total billed charges,29.13,37.27,,23.3,percent of total billed charges,37.27% of total billed charges,29.13,37.27,,23.3,percent of total billed charges,37.27% of total billed charges,29.13,37.27,,23.3,percent of total billed charges,37.27% 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,31.26,40,,25.01,percent of total billed charges,40% of total billed charges,29.13,62.52,
MYRBETRIQ,5880901,CDM,637,RC,,,Outpatient,,,62.75,50.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,50.2,80,,40.16,percent of total billed charges,80% of total billed charges,23.39,37.27,,18.71,percent of total billed charges,37.27% of total billed charges,23.39,37.27,,18.71,percent of total billed charges,37.27% of total billed charges,23.39,37.27,,18.71,percent of total billed charges,37.27% 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,25.1,40,,20.08,percent of total billed charges,40% of total billed charges,23.39,50.2,
US FETAL BIO PROFILE,6000566,CDM,402,RC,76819,HCPCS,Outpatient,,,300,240.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,63.25,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,63.25,240,
US DOPLR VEL FETAL U,6000566,CDM,402,RC,76820,HCPCS,Outpatient,,,300,240.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,27.19,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,27.19,240,
US FETAL BIO PROF W,6000566,CDM,402,RC,76818,HCPCS,Outpatient,,,300,240.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,240,80,,192,percent of total billed charges,80% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,111.81,37.27,,89.45,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,88.33,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,40,,96,percent of total billed charges,40% of total billed charges,88.33,240,
ANORO ELLIPTA 62.6-2,6400014,CDM,250,RC,,,Outpatient,,,1487.15,1189.72,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1189.72,80,,951.78,percent of total billed charges,80% of total billed charges,554.26,37.27,,443.41,percent of total billed charges,37.27% of total billed charges,554.26,37.27,,443.41,percent of total billed charges,37.27% of total billed charges,554.26,37.27,,443.41,percent of total billed charges,37.27% 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,594.86,40,,475.89,percent of total billed charges,40% of total billed charges,554.26,1189.72,
JARDIANCE 10MG,6400014,CDM,250,RC,,,Outpatient,,,83.35,66.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.68,80,,53.34,percent of total billed charges,80% of total billed charges,31.06,37.27,,24.85,percent of total billed charges,37.27% of total billed charges,31.06,37.27,,24.85,percent of total billed charges,37.27% of total billed charges,31.06,37.27,,24.85,percent of total billed charges,37.27% 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,33.34,40,,26.67,percent of total billed charges,40% of total billed charges,31.06,66.68,
BELSOMRA 10MG,6400014,CDM,250,RC,,,Outpatient,,,44.15,35.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.32,80,,28.26,percent of total billed charges,80% of total billed charges,16.45,37.27,,13.16,percent of total billed charges,37.27% of total billed charges,16.45,37.27,,13.16,percent of total billed charges,37.27% of total billed charges,16.45,37.27,,13.16,percent of total billed charges,37.27% 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,17.66,40,,14.13,percent of total billed charges,40% of total billed charges,16.45,35.32,
FLU ZONE QUADRIVALEN,6065130,CDM,636,RC,90686,HCPCS,Outpatient,,,157.6,126.08,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126.08,80,,100.86,percent of total billed charges,80% of total billed charges,58.74,37.27,,46.99,percent of total billed charges,37.27% of total billed charges,58.74,37.27,,46.99,percent of total billed charges,37.27% of total billed charges,58.74,37.27,,46.99,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,21.52,100,,,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,63.04,40,,50.43,percent of total billed charges,40% of total billed charges,21.52,126.08,
ABILIFY 2MG TABS,6400014,CDM,250,RC,,,Outpatient,,,99.55,79.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.64,80,,63.71,percent of total billed charges,80% of total billed charges,37.1,37.27,,29.68,percent of total billed charges,37.27% of total billed charges,37.1,37.27,,29.68,percent of total billed charges,37.27% of total billed charges,37.1,37.27,,29.68,percent of total billed charges,37.27% 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,39.82,40,,31.86,percent of total billed charges,40% of total billed charges,37.1,79.64,
EAR VENT TUBE 1.14,5645742,CDM,270,RC,,,Outpatient,,,44.18,35.34,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.34,80,,28.27,percent of total billed charges,80% of total billed charges,16.47,37.27,,13.18,percent of total billed charges,37.27% of total billed charges,16.47,37.27,,13.18,percent of total billed charges,37.27% of total billed charges,16.47,37.27,,13.18,percent of total billed charges,37.27% 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,17.67,40,,14.14,percent of total billed charges,40% of total billed charges,16.47,35.34,
EAR VNT TUBE 1016020,5645742,CDM,270,RC,,,Outpatient,,,55.85,44.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.68,80,,35.74,percent of total billed charges,80% of total billed charges,20.82,37.27,,16.66,percent of total billed charges,37.27% of total billed charges,20.82,37.27,,16.66,percent of total billed charges,37.27% of total billed charges,20.82,37.27,,16.66,percent of total billed charges,37.27% 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,22.34,40,,17.87,percent of total billed charges,40% of total billed charges,20.82,44.68,
EAR VNT TUBE 1026011,5645742,CDM,270,RC,,,Outpatient,,,55.85,44.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44.68,80,,35.74,percent of total billed charges,80% of total billed charges,20.82,37.27,,16.66,percent of total billed charges,37.27% of total billed charges,20.82,37.27,,16.66,percent of total billed charges,37.27% of total billed charges,20.82,37.27,,16.66,percent of total billed charges,37.27% 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,22.34,40,,17.87,percent of total billed charges,40% of total billed charges,20.82,44.68,
EAR VNT TUBE 1016025,5645742,CDM,270,RC,,,Outpatient,,,109.73,87.78,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.78,80,,70.22,percent of total billed charges,80% of total billed charges,40.9,37.27,,32.72,percent of total billed charges,37.27% of total billed charges,40.9,37.27,,32.72,percent of total billed charges,37.27% of total billed charges,40.9,37.27,,32.72,percent of total billed charges,37.27% 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,43.89,40,,35.11,percent of total billed charges,40% of total billed charges,40.9,87.78,
EAR VENT TUBE 5.8,5645742,CDM,270,RC,,,Outpatient,,,72.95,58.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.36,80,,46.69,percent of total billed charges,80% of total billed charges,27.19,37.27,,21.75,percent of total billed charges,37.27% of total billed charges,27.19,37.27,,21.75,percent of total billed charges,37.27% of total billed charges,27.19,37.27,,21.75,percent of total billed charges,37.27% 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,29.18,40,,23.34,percent of total billed charges,40% of total billed charges,27.19,58.36,
EAR VNT TUBE 1026040,5645742,CDM,270,RC,,,Outpatient,,,58.43,46.74,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.74,80,,37.39,percent of total billed charges,80% of total billed charges,21.78,37.27,,17.42,percent of total billed charges,37.27% of total billed charges,21.78,37.27,,17.42,percent of total billed charges,37.27% of total billed charges,21.78,37.27,,17.42,percent of total billed charges,37.27% 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,23.37,40,,18.7,percent of total billed charges,40% of total billed charges,21.78,46.74,
EAR VNT TUBE 1040002,5645742,CDM,270,RC,,,Outpatient,,,73.53,58.82,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.82,80,,47.06,percent of total billed charges,80% of total billed charges,27.4,37.27,,21.92,percent of total billed charges,37.27% of total billed charges,27.4,37.27,,21.92,percent of total billed charges,37.27% of total billed charges,27.4,37.27,,21.92,percent of total billed charges,37.27% 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,29.41,40,,23.53,percent of total billed charges,40% of total billed charges,27.4,58.82,
US VENOUS MAP BILAT,6012447,CDM,921,RC,93985,HCPCS,Outpatient,,,286,228.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,267.73,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.4,40,,91.52,percent of total billed charges,40% of total billed charges,106.59,267.73,
TORCH IGG,7012032,CDM,300,RC,,,Outpatient,,,441,352.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352.8,80,,282.24,percent of total billed charges,80% of total billed charges,164.36,37.27,,131.49,percent of total billed charges,37.27% of total billed charges,164.36,37.27,,131.49,percent of total billed charges,37.27% of total billed charges,164.36,37.27,,131.49,percent of total billed charges,37.27% 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,176.4,40,,141.12,percent of total billed charges,40% of total billed charges,164.36,352.8,
TORCH IGM,7012032,CDM,300,RC,,,Outpatient,,,381,304.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,304.8,80,,243.84,percent of total billed charges,80% of total billed charges,142,37.27,,113.6,percent of total billed charges,37.27% of total billed charges,142,37.27,,113.6,percent of total billed charges,37.27% of total billed charges,142,37.27,,113.6,percent of total billed charges,37.27% 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,152.4,40,,121.92,percent of total billed charges,40% of total billed charges,142,304.8,
LEAD INTRO KIT,5801832,CDM,272,RC,,,Outpatient,,,700,560.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,560,80,,448,percent of total billed charges,80% of total billed charges,260.89,37.27,,208.71,percent of total billed charges,37.27% of total billed charges,260.89,37.27,,208.71,percent of total billed charges,37.27% of total billed charges,260.89,37.27,,208.71,percent of total billed charges,37.27% 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,280,40,,224,percent of total billed charges,40% of total billed charges,260.89,560,
LEAD KIT,8605396,CDM,278,RC,C1778,HCPCS,Outpatient,,,8890,7112.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7112,80,,5689.6,percent of total billed charges,80% of total billed charges,3313.3,37.27,,2650.64,percent of total billed charges,37.27% of total billed charges,3313.3,37.27,,2650.64,percent of total billed charges,37.27% of total billed charges,3313.3,37.27,,2650.64,percent of total billed charges,37.27% 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,3556,40,,2844.8,percent of total billed charges,40% of total billed charges,3313.3,7112,
CABLE TWIST LOCK,5801832,CDM,272,RC,,,Outpatient,,,200,160.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160,80,,128,percent of total billed charges,80% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% 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,80,40,,64,percent of total billed charges,40% of total billed charges,74.54,160,
CABLE TEST STIM,5801832,CDM,272,RC,,,Outpatient,,,100,80.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% 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,40,40,,32,percent of total billed charges,40% of total billed charges,37.27,80,
EXTRNL NROSTIMULATOR,5801832,CDM,272,RC,,,Outpatient,,,1000,800.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,800,80,,640,percent of total billed charges,80% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% 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,400,40,,320,percent of total billed charges,40% of total billed charges,372.7,800,
LATUDA 40MG TAB,5880901,CDM,637,RC,,,Outpatient,,,164.55,131.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,131.64,80,,105.31,percent of total billed charges,80% of total billed charges,61.33,37.27,,49.06,percent of total billed charges,37.27% of total billed charges,61.33,37.27,,49.06,percent of total billed charges,37.27% of total billed charges,61.33,37.27,,49.06,percent of total billed charges,37.27% 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,65.82,40,,52.66,percent of total billed charges,40% of total billed charges,61.33,131.64,
TESTOSTERONE CYP 200,6065130,CDM,636,RC,J1071,HCPCS,Outpatient,,,79.05,63.24,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.24,80,,50.59,percent of total billed charges,80% of total billed charges,29.46,37.27,,23.57,percent of total billed charges,37.27% of total billed charges,29.46,37.27,,23.57,percent of total billed charges,37.27% of total billed charges,29.46,37.27,,23.57,percent of total billed charges,37.27% 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,31.62,40,,25.3,percent of total billed charges,40% of total billed charges,29.46,63.24,
INTERSTIM ANTENNA,5801832,CDM,272,RC,,,Outpatient,,,200,160.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160,80,,128,percent of total billed charges,80% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% of total billed charges,74.54,37.27,,59.63,percent of total billed charges,37.27% 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,80,40,,64,percent of total billed charges,40% of total billed charges,74.54,160,
INTERSTIM PROGRMR,8605396,CDM,278,RC,C1787,HCPCS,Outpatient,,,2975,2380.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2380,80,,1904,percent of total billed charges,80% of total billed charges,1108.78,37.27,,887.02,percent of total billed charges,37.27% of total billed charges,1108.78,37.27,,887.02,percent of total billed charges,37.27% of total billed charges,1108.78,37.27,,887.02,percent of total billed charges,37.27% 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,1190,40,,952,percent of total billed charges,40% of total billed charges,1108.78,2380,
INTERSTIM IPG 3058,8605396,CDM,278,RC,C1767,HCPCS,Outpatient,,,29200,23360.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23360,80,,18688,percent of total billed charges,80% of total billed charges,10882.84,37.27,,8706.27,percent of total billed charges,37.27% of total billed charges,10882.84,37.27,,8706.27,percent of total billed charges,37.27% of total billed charges,10882.84,37.27,,8706.27,percent of total billed charges,37.27% 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,11680,40,,9344,percent of total billed charges,40% of total billed charges,10882.84,23360,
MAMMO DIAG UNILAT 3D,6001815,CDM,401,RC,77061,HCPCS,Outpatient,,,100,80.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% 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,40,40,,32,percent of total billed charges,40% of total billed charges,37.27,80,
MAMMO DIAG BILAT 3D,6001815,CDM,401,RC,77062,HCPCS,Outpatient,,,115,92.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92,80,,73.6,percent of total billed charges,80% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% of total billed charges,42.86,37.27,,34.29,percent of total billed charges,37.27% 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,46,40,,36.8,percent of total billed charges,40% of total billed charges,42.86,92,
MEMANTINE ER 7MG,5880901,CDM,637,RC,,,Outpatient,,,52.05,41.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.64,80,,33.31,percent of total billed charges,80% of total billed charges,19.4,37.27,,15.52,percent of total billed charges,37.27% of total billed charges,19.4,37.27,,15.52,percent of total billed charges,37.27% of total billed charges,19.4,37.27,,15.52,percent of total billed charges,37.27% 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,20.82,40,,16.66,percent of total billed charges,40% of total billed charges,19.4,41.64,
AMNIOFIX 3X3 IMPLANT,8605396,CDM,278,RC,Q4186,HCPCS,Outpatient,,,3488,2790.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2790.4,80,,2232.32,percent of total billed charges,80% of total billed charges,1299.98,37.27,,1039.98,percent of total billed charges,37.27% of total billed charges,1299.98,37.27,,1039.98,percent of total billed charges,37.27% of total billed charges,1299.98,37.27,,1039.98,percent of total billed charges,37.27% 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,1395.2,40,,1116.16,percent of total billed charges,40% of total billed charges,1299.98,2790.4,
IMP OSTEOSET 5CC,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1875,1500.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1500,80,,1200,percent of total billed charges,80% of total billed charges,698.81,37.27,,559.05,percent of total billed charges,37.27% of total billed charges,698.81,37.27,,559.05,percent of total billed charges,37.27% of total billed charges,698.81,37.27,,559.05,percent of total billed charges,37.27% 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,750,40,,600,percent of total billed charges,40% of total billed charges,698.81,1500,
IMP OSTOSET 25CC,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,9375,7500.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7500,80,,6000,percent of total billed charges,80% of total billed charges,3494.06,37.27,,2795.25,percent of total billed charges,37.27% of total billed charges,3494.06,37.27,,2795.25,percent of total billed charges,37.27% of total billed charges,3494.06,37.27,,2795.25,percent of total billed charges,37.27% 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,3750,40,,3000,percent of total billed charges,40% of total billed charges,3494.06,7500,
C-ARM FLURO 1ST HOUR,8605396,CDM,278,RC,76000,HCPCS,Outpatient,,,449,359.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,359.2,80,,287.36,percent of total billed charges,80% of total billed charges,167.34,37.27,,133.87,percent of total billed charges,37.27% of total billed charges,167.34,37.27,,133.87,percent of total billed charges,37.27% of total billed charges,167.34,37.27,,133.87,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,35.64,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,179.6,40,,143.68,percent of total billed charges,40% of total billed charges,35.64,359.2,
REXULTI 2MG TAB,6400014,CDM,250,RC,,,Outpatient,,,135.1,108.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.08,80,,86.46,percent of total billed charges,80% of total billed charges,50.35,37.27,,40.28,percent of total billed charges,37.27% of total billed charges,50.35,37.27,,40.28,percent of total billed charges,37.27% of total billed charges,50.35,37.27,,40.28,percent of total billed charges,37.27% 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,54.04,40,,43.23,percent of total billed charges,40% of total billed charges,50.35,108.08,
BONEGRAFT DELKIT 514,5801832,CDM,272,RC,,,Outpatient,,,7650,6120.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6120,80,,4896,percent of total billed charges,80% of total billed charges,2851.16,37.27,,2280.93,percent of total billed charges,37.27% of total billed charges,2851.16,37.27,,2280.93,percent of total billed charges,37.27% of total billed charges,2851.16,37.27,,2280.93,percent of total billed charges,37.27% 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,3060,40,,2448,percent of total billed charges,40% of total billed charges,2851.16,6120,
RESEC LOOP ELECTRODE,5801832,CDM,272,RC,,,Outpatient,,,1082,865.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,865.6,80,,692.48,percent of total billed charges,80% of total billed charges,403.26,37.27,,322.61,percent of total billed charges,37.27% of total billed charges,403.26,37.27,,322.61,percent of total billed charges,37.27% of total billed charges,403.26,37.27,,322.61,percent of total billed charges,37.27% 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,432.8,40,,346.24,percent of total billed charges,40% of total billed charges,403.26,865.6,
K+ 20MEQ EFFER TAB,5880901,CDM,637,RC,,,Outpatient,,,2.25,1.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.8,80,,1.44,percent of total billed charges,80% of total billed charges,0.84,37.27,,0.67,percent of total billed charges,37.27% of total billed charges,0.84,37.27,,0.67,percent of total billed charges,37.27% of total billed charges,0.84,37.27,,0.67,percent of total billed charges,37.27% 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,0.9,40,,0.72,percent of total billed charges,40% of total billed charges,0.84,1.8,
COCAINE 4% TOP SOL,5880901,CDM,637,RC,,,Outpatient,,,852.6,682.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,682.08,80,,545.66,percent of total billed charges,80% of total billed charges,317.76,37.27,,254.21,percent of total billed charges,37.27% of total billed charges,317.76,37.27,,254.21,percent of total billed charges,37.27% of total billed charges,317.76,37.27,,254.21,percent of total billed charges,37.27% 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,341.04,40,,272.83,percent of total billed charges,40% of total billed charges,317.76,682.08,
TRILEPTAL 150MG TAB,6400014,CDM,250,RC,,,Outpatient,,,5.1,4.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.08,80,,3.26,percent of total billed charges,80% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% of total billed charges,1.9,37.27,,1.52,percent of total billed charges,37.27% 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,2.04,40,,1.63,percent of total billed charges,40% of total billed charges,1.9,4.08,
GAMUNEX-C 40GM,6065130,CDM,636,RC,J1561,HCPCS,Outpatient,,,195.62,156.50,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.5,80,,125.2,percent of total billed charges,80% of total billed charges,72.91,37.27,,58.33,percent of total billed charges,37.27% of total billed charges,72.91,37.27,,58.33,percent of total billed charges,37.27% of total billed charges,72.91,37.27,,58.33,percent of total billed charges,37.27% of total billed charges,48.81,100,,,fee schedule,100% of APC rate,48.81,100,,,fee schedule,100% of APC rate,48.81,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,48.81,100,,,fee schedule,100% of APC rate,48.81,100,,,fee schedule,100% of APC rate,48.81,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.25,40,,62.6,percent of total billed charges,40% of total billed charges,48.81,156.5,
GAMUNEX-C 10GM,6065130,CDM,636,RC,J1561,HCPCS,Outpatient,,,195.62,156.50,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.5,80,,125.2,percent of total billed charges,80% of total billed charges,72.91,37.27,,58.33,percent of total billed charges,37.27% of total billed charges,72.91,37.27,,58.33,percent of total billed charges,37.27% of total billed charges,72.91,37.27,,58.33,percent of total billed charges,37.27% of total billed charges,48.81,100,,,fee schedule,100% of APC rate,48.81,100,,,fee schedule,100% of APC rate,48.81,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,48.81,100,,,fee schedule,100% of APC rate,48.81,100,,,fee schedule,100% of APC rate,48.81,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,78.25,40,,62.6,percent of total billed charges,40% of total billed charges,48.81,156.5,
RID SHAMPOO,6400014,CDM,250,RC,,,Outpatient,,,3.25,2.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.6,80,,2.08,percent of total billed charges,80% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% of total billed charges,1.21,37.27,,0.97,percent of total billed charges,37.27% 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,1.3,40,,1.04,percent of total billed charges,40% of total billed charges,1.21,2.6,
AMNIOFIX 2X2 IMPLANT,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1988,1590.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1590.4,80,,1272.32,percent of total billed charges,80% of total billed charges,740.93,37.27,,592.74,percent of total billed charges,37.27% of total billed charges,740.93,37.27,,592.74,percent of total billed charges,37.27% of total billed charges,740.93,37.27,,592.74,percent of total billed charges,37.27% 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,795.2,40,,636.16,percent of total billed charges,40% of total billed charges,740.93,1590.4,
IMP ANCHOR 2.5X10MM,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1144.88,915.90,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,915.9,80,,732.72,percent of total billed charges,80% of total billed charges,426.7,37.27,,341.36,percent of total billed charges,37.27% of total billed charges,426.7,37.27,,341.36,percent of total billed charges,37.27% of total billed charges,426.7,37.27,,341.36,percent of total billed charges,37.27% 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,457.95,40,,366.36,percent of total billed charges,40% of total billed charges,426.7,915.9,
IMP SCREW (SIZE),8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1119.6,895.68,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,895.68,80,,716.54,percent of total billed charges,80% of total billed charges,417.27,37.27,,333.82,percent of total billed charges,37.27% of total billed charges,417.27,37.27,,333.82,percent of total billed charges,37.27% of total billed charges,417.27,37.27,,333.82,percent of total billed charges,37.27% 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,447.84,40,,358.27,percent of total billed charges,40% of total billed charges,417.27,895.68,
US TRANS/ABDOM <14WK,6000566,CDM,402,RC,76802,HCPCS,Outpatient,,,75,60.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,80,,48,percent of total billed charges,80% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% of total billed charges,27.95,37.27,,22.36,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.64,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30,40,,24,percent of total billed charges,40% of total billed charges,26.64,60,
OPCE OB DIRECT ADMIT,8399990,CDM,762,RC,G0379,HCPCS,Outpatient,,,1300,1040.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1040,80,,832,percent of total billed charges,80% of total billed charges,484.51,37.27,,387.61,percent of total billed charges,37.27% of total billed charges,484.51,37.27,,387.61,percent of total billed charges,37.27% of total billed charges,484.51,37.27,,387.61,percent of total billed charges,37.27% of total billed charges,529.59,100,,,fee schedule,100% of APC rate,529.59,100,,,fee schedule,100% of APC rate,529.59,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,529.59,100,,,fee schedule,100% of APC rate,529.59,100,,,fee schedule,100% of APC rate,529.59,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520,40,,416,percent of total billed charges,40% of total billed charges,484.51,1040,
IV/INF THERAPY SEQ I,5811182,CDM,260,RC,96367,HCPCS,Outpatient,,,130,104.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104,80,,83.2,percent of total billed charges,80% of total billed charges,48.45,37.27,,38.76,percent of total billed charges,37.27% of total billed charges,48.45,37.27,,38.76,percent of total billed charges,37.27% of total billed charges,48.45,37.27,,38.76,percent of total billed charges,37.27% of total billed charges,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,37.19,145,,,fee schedule,145% of CMS fee schedule,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,58.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52,40,,41.6,percent of total billed charges,40% of total billed charges,37.19,104,
US TRANABD <14WK 1ST,6000566,CDM,402,RC,76801,HCPCS,Outpatient,,,286,228.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.18,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.4,40,,91.52,percent of total billed charges,40% of total billed charges,90.18,228.8,
US TRANABD >14WK EA,6000566,CDM,402,RC,76810,HCPCS,Outpatient,,,120,96.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96,80,,76.8,percent of total billed charges,80% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,44.72,37.27,,35.78,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52.55,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48,40,,38.4,percent of total billed charges,40% of total billed charges,44.72,96,
NICOTENE GUM 4MG,6400014,CDM,250,RC,,,Outpatient,,,1.7,1.36,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.36,80,,1.09,percent of total billed charges,80% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% of total billed charges,0.63,37.27,,0.5,percent of total billed charges,37.27% 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,0.68,40,,0.54,percent of total billed charges,40% of total billed charges,0.63,1.36,
PHENOBARBITAL INJ 65,6065130,CDM,636,RC,J2560,HCPCS,Outpatient,,,104.65,83.72,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.72,80,,66.98,percent of total billed charges,80% of total billed charges,39,37.27,,31.2,percent of total billed charges,37.27% of total billed charges,39,37.27,,31.2,percent of total billed charges,37.27% of total billed charges,39,37.27,,31.2,percent of total billed charges,37.27% 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,41.86,40,,33.49,percent of total billed charges,40% of total billed charges,39,83.72,
US ECHOENCPHALOGRPHY,6000566,CDM,402,RC,76506,HCPCS,Outpatient,,,286.15,228.92,26,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.92,80,,183.14,percent of total billed charges,80% of total billed charges,106.65,37.27,,85.32,percent of total billed charges,37.27% of total billed charges,106.65,37.27,,85.32,percent of total billed charges,37.27% of total billed charges,106.65,37.27,,85.32,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,104.56,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.46,40,,91.57,percent of total billed charges,40% of total billed charges,90.64,228.92,
IV INF THERAPY CONC,5811182,CDM,260,RC,96368,HCPCS,Outpatient,,,146,116.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116.8,80,,93.44,percent of total billed charges,80% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,54.41,37.27,,43.53,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.09,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,40,,46.72,percent of total billed charges,40% of total billed charges,26.09,116.8,
VICTOZA 6MG/ML,6065130,CDM,636,RC,,,Outpatient,,,395.75,316.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,316.6,80,,253.28,percent of total billed charges,80% of total billed charges,147.5,37.27,,118,percent of total billed charges,37.27% of total billed charges,147.5,37.27,,118,percent of total billed charges,37.27% of total billed charges,147.5,37.27,,118,percent of total billed charges,37.27% 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,158.3,40,,126.64,percent of total billed charges,40% of total billed charges,147.5,316.6,
ADDERALL 5MG TAB,6400014,CDM,250,RC,,,Outpatient,,,6.05,4.84,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.84,80,,3.87,percent of total billed charges,80% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% of total billed charges,2.25,37.27,,1.8,percent of total billed charges,37.27% 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,2.42,40,,1.94,percent of total billed charges,40% of total billed charges,2.25,4.84,
US NONVAS EXT LMTD,6000566,CDM,402,RC,76882,HCPCS,Outpatient,,,286,228.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,39.44,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.4,40,,91.52,percent of total billed charges,40% of total billed charges,39.44,228.8,
RISPERDAL 1MG/ML,6400014,CDM,250,RC,,,Outpatient,,,397.65,318.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.12,80,,254.5,percent of total billed charges,80% of total billed charges,148.2,37.27,,118.56,percent of total billed charges,37.27% of total billed charges,148.2,37.27,,118.56,percent of total billed charges,37.27% of total billed charges,148.2,37.27,,118.56,percent of total billed charges,37.27% 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,159.06,40,,127.25,percent of total billed charges,40% of total billed charges,148.2,318.12,
US VAG PROBE/PLVS OB,6000566,CDM,402,RC,76817,HCPCS,Outpatient,,,286,228.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228.8,80,,183.04,percent of total billed charges,80% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,106.59,37.27,,85.27,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,72.85,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.4,40,,91.52,percent of total billed charges,40% of total billed charges,72.85,228.8,
US RENAL ARTERY DOP,6012447,CDM,921,RC,93975,HCPCS,Outpatient,,,580,464.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,464,80,,371.2,percent of total billed charges,80% of total billed charges,216.17,37.27,,172.94,percent of total billed charges,37.27% of total billed charges,216.17,37.27,,172.94,percent of total billed charges,37.27% of total billed charges,216.17,37.27,,172.94,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,267.31,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,232,40,,185.6,percent of total billed charges,40% of total billed charges,202.03,464,
CROMOLYN 4% EYE DROP,5880901,CDM,637,RC,,,Outpatient,,,127,101.60,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,101.6,80,,81.28,percent of total billed charges,80% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% of total billed charges,47.33,37.27,,37.86,percent of total billed charges,37.27% 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,50.8,40,,40.64,percent of total billed charges,40% of total billed charges,47.33,101.6,
CLINDAMYCIN 600/D5W,6065130,CDM,636,RC,J0736,HCPCS,Outpatient,,,50.55,40.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40.44,80,,32.35,percent of total billed charges,80% of total billed charges,18.84,37.27,,15.07,percent of total billed charges,37.27% of total billed charges,18.84,37.27,,15.07,percent of total billed charges,37.27% of total billed charges,18.84,37.27,,15.07,percent of total billed charges,37.27% of total billed charges,2.47,100,,,fee schedule,100% of APC rate,2.47,100,,,fee schedule,100% of APC rate,2.47,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,2.47,100,,,fee schedule,100% of APC rate,2.47,100,,,fee schedule,100% of APC rate,2.47,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20.22,40,,16.18,percent of total billed charges,40% of total billed charges,2.47,40.44,
NALTREXONE 50MG TAB,6400014,CDM,250,RC,,,Outpatient,,,14.7,11.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.76,80,,9.41,percent of total billed charges,80% of total billed charges,5.48,37.27,,4.38,percent of total billed charges,37.27% of total billed charges,5.48,37.27,,4.38,percent of total billed charges,37.27% of total billed charges,5.48,37.27,,4.38,percent of total billed charges,37.27% 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,5.88,40,,4.7,percent of total billed charges,40% of total billed charges,5.48,11.76,
ALBUTEROL INHALER,6400014,CDM,250,RC,,,Outpatient,,,249.7,199.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,199.76,80,,159.81,percent of total billed charges,80% of total billed charges,93.06,37.27,,74.45,percent of total billed charges,37.27% of total billed charges,93.06,37.27,,74.45,percent of total billed charges,37.27% of total billed charges,93.06,37.27,,74.45,percent of total billed charges,37.27% 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,99.88,40,,79.9,percent of total billed charges,40% of total billed charges,93.06,199.76,
DRE HYDRO BLUE 4X5,5801832,CDM,272,RC,A6210,HCPCS,Outpatient,,,15,12.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12,80,,9.6,percent of total billed charges,80% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,5.59,37.27,,4.47,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.19,100,,,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,6,40,,4.8,percent of total billed charges,40% of total billed charges,5.59,27.19,
AQUACEL AG EXTRA 4X5,5801832,CDM,272,RC,A6197,HCPCS,Outpatient,,,17.45,13.96,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.96,80,,11.17,percent of total billed charges,80% of total billed charges,6.5,37.27,,5.2,percent of total billed charges,37.27% of total billed charges,6.5,37.27,,5.2,percent of total billed charges,37.27% of total billed charges,6.5,37.27,,5.2,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.44,100,,,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,6.98,40,,5.58,percent of total billed charges,40% of total billed charges,6.5,22.44,
AQUAC AG ROPE .39X18,5801832,CDM,272,RC,A6199,HCPCS,Outpatient,,,20.9,16.72,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16.72,80,,13.38,percent of total billed charges,80% of total billed charges,7.79,37.27,,6.23,percent of total billed charges,37.27% of total billed charges,7.79,37.27,,6.23,percent of total billed charges,37.27% of total billed charges,7.79,37.27,,6.23,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,100,,,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,8.36,40,,6.69,percent of total billed charges,40% of total billed charges,7.2,16.72,
COBAN 2LAYER COMPRES,5645742,CDM,270,RC,,,Outpatient,,,13.18,10.54,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.54,80,,8.43,percent of total billed charges,80% of total billed charges,4.91,37.27,,3.93,percent of total billed charges,37.27% of total billed charges,4.91,37.27,,3.93,percent of total billed charges,37.27% of total billed charges,4.91,37.27,,3.93,percent of total billed charges,37.27% 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,5.27,40,,4.22,percent of total billed charges,40% of total billed charges,4.91,10.54,
MEDIHONEY 3/4X12,5801832,CDM,272,RC,A6199,HCPCS,Outpatient,,,17.4,13.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.92,80,,11.14,percent of total billed charges,80% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% of total billed charges,6.48,37.27,,5.18,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,100,,,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,6.96,40,,5.57,percent of total billed charges,40% of total billed charges,6.48,13.92,
MEDIHONE CAL ALG 4X5,5801832,CDM,272,RC,A6197,HCPCS,Outpatient,,,21.53,17.22,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.22,80,,13.78,percent of total billed charges,80% of total billed charges,8.02,37.27,,6.42,percent of total billed charges,37.27% of total billed charges,8.02,37.27,,6.42,percent of total billed charges,37.27% of total billed charges,8.02,37.27,,6.42,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,22.44,100,,,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,8.61,40,,6.89,percent of total billed charges,40% of total billed charges,8.02,22.44,
BUSPIRONE 15MG,6400014,CDM,250,RC,,,Outpatient,,,6.85,5.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.48,80,,4.38,percent of total billed charges,80% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% of total billed charges,2.55,37.27,,2.04,percent of total billed charges,37.27% 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,2.74,40,,2.19,percent of total billed charges,40% of total billed charges,2.55,5.48,
INVEGA SUSTENNA 156M,6065130,CDM,636,RC,J2426,HCPCS,Outpatient,,,6400.95,5120.76,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5120.76,80,,4096.61,percent of total billed charges,80% of total billed charges,2385.63,37.27,,1908.5,percent of total billed charges,37.27% of total billed charges,2385.63,37.27,,1908.5,percent of total billed charges,37.27% of total billed charges,2385.63,37.27,,1908.5,percent of total billed charges,37.27% of total billed charges,14.76,100,,,fee schedule,100% of APC rate,14.76,100,,,fee schedule,100% of APC rate,14.76,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,14.76,100,,,fee schedule,100% of APC rate,14.76,100,,,fee schedule,100% of APC rate,14.76,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2560.38,40,,2048.3,percent of total billed charges,40% of total billed charges,14.76,5120.76,
DILANTIN 30MG,5880901,CDM,637,RC,,,Outpatient,,,5.95,4.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.76,80,,3.81,percent of total billed charges,80% of total billed charges,2.22,37.27,,1.78,percent of total billed charges,37.27% of total billed charges,2.22,37.27,,1.78,percent of total billed charges,37.27% of total billed charges,2.22,37.27,,1.78,percent of total billed charges,37.27% 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,2.38,40,,1.9,percent of total billed charges,40% of total billed charges,2.22,4.76,
DULERA INHALER,5880901,CDM,637,RC,,,Outpatient,,,733.4,586.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,586.72,80,,469.38,percent of total billed charges,80% of total billed charges,273.34,37.27,,218.67,percent of total billed charges,37.27% of total billed charges,273.34,37.27,,218.67,percent of total billed charges,37.27% of total billed charges,273.34,37.27,,218.67,percent of total billed charges,37.27% 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,293.36,40,,234.69,percent of total billed charges,40% of total billed charges,273.34,586.72,
PIMOZIDE 1MG TAB,6400014,CDM,250,RC,,,Outpatient,,,6.2,4.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.96,80,,3.97,percent of total billed charges,80% of total billed charges,2.31,37.27,,1.85,percent of total billed charges,37.27% of total billed charges,2.31,37.27,,1.85,percent of total billed charges,37.27% of total billed charges,2.31,37.27,,1.85,percent of total billed charges,37.27% 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,2.48,40,,1.98,percent of total billed charges,40% of total billed charges,2.31,4.96,
SPIRIVA RESPIMAT,6400014,CDM,250,RC,,,Outpatient,,,581.2,464.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,464.96,80,,371.97,percent of total billed charges,80% of total billed charges,216.61,37.27,,173.29,percent of total billed charges,37.27% of total billed charges,216.61,37.27,,173.29,percent of total billed charges,37.27% of total billed charges,216.61,37.27,,173.29,percent of total billed charges,37.27% 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,232.48,40,,185.98,percent of total billed charges,40% of total billed charges,216.61,464.96,
CTA HEAD W/WO CONT,6010052,CDM,350,RC,70496,HCPCS,Outpatient,,,1000,800.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,800,80,,640,percent of total billed charges,80% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,372.7,37.27,,298.16,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,255.77,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,400,40,,320,percent of total billed charges,40% of total billed charges,151.49,800,
SUGAMMADEX 200MG/2ML,6400014,CDM,250,RC,,,Outpatient,,,530.55,424.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,424.44,80,,339.55,percent of total billed charges,80% of total billed charges,197.74,37.27,,158.19,percent of total billed charges,37.27% of total billed charges,197.74,37.27,,158.19,percent of total billed charges,37.27% of total billed charges,197.74,37.27,,158.19,percent of total billed charges,37.27% 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,212.22,40,,169.78,percent of total billed charges,40% of total billed charges,197.74,424.44,
SYNTHROID 25MCG TAB,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
GAMUNEX 10GM/100ML,6065130,CDM,636,RC,,,Outpatient,,,1,0.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,80,,0.64,percent of total billed charges,80% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% 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,0.4,40,,0.32,percent of total billed charges,40% of total billed charges,0.37,0.8,
TELEMED FAC CHARGE,3312618,CDM,780,RC,Q3014,HCPCS,Outpatient,,,65,52.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% 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,26,40,,20.8,percent of total billed charges,40% of total billed charges,24.23,52,
TELEMED FAC CHG TELE,3312618,CDM,780,RC,Q3014,HCPCS,Outpatient,,,65,52.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% 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,26,40,,20.8,percent of total billed charges,40% of total billed charges,24.23,52,
TELEHEALTH FAC FEE,3312618,CDM,780,RC,Q3014,HCPCS,Outpatient,,,65,52.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52,80,,41.6,percent of total billed charges,80% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% of total billed charges,24.23,37.27,,19.38,percent of total billed charges,37.27% 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,26,40,,20.8,percent of total billed charges,40% of total billed charges,24.23,52,
EVENITY 210MG,6065130,CDM,636,RC,J3111,HCPCS,Outpatient,,,2983.25,2386.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2386.6,80,,1909.28,percent of total billed charges,80% of total billed charges,1111.86,37.27,,889.49,percent of total billed charges,37.27% of total billed charges,1111.86,37.27,,889.49,percent of total billed charges,37.27% of total billed charges,1111.86,37.27,,889.49,percent of total billed charges,37.27% of total billed charges,11.17,100,,,fee schedule,100% of APC rate,11.17,100,,,fee schedule,100% of APC rate,11.17,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,11.17,100,,,fee schedule,100% of APC rate,11.17,100,,,fee schedule,100% of APC rate,11.17,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1193.3,40,,954.64,percent of total billed charges,40% of total billed charges,11.17,2386.6,
EPIFIX MESH 3.5X 3.5,6065130,CDM,636,RC,Q4186,HCPCS,Outpatient,,,3113,2490.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2490.4,80,,1992.32,percent of total billed charges,80% of total billed charges,1160.22,37.27,,928.18,percent of total billed charges,37.27% of total billed charges,1160.22,37.27,,928.18,percent of total billed charges,37.27% of total billed charges,1160.22,37.27,,928.18,percent of total billed charges,37.27% 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,1245.2,40,,996.16,percent of total billed charges,40% of total billed charges,1160.22,2490.4,
ICU-MEDSUR BED OVER,13003,CDM,110,RC,,,Inpatient,,,778,622.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,622.4,80,,497.92,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,622.4,622.4,
ICU-TELE BED OVERFLO,22004,CDM,206,RC,,,Inpatient,,,1297,1037.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1037.6,80,,830.08,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,1037.6,1037.6,
CALC GLUC1000MG/10ML,6065130,CDM,636,RC,J0613,HCPCS,Outpatient,,,80.8,64.64,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.64,80,,51.71,percent of total billed charges,80% of total billed charges,30.11,37.27,,24.09,percent of total billed charges,37.27% of total billed charges,30.11,37.27,,24.09,percent of total billed charges,37.27% of total billed charges,30.11,37.27,,24.09,percent of total billed charges,37.27% of total billed charges,0.07,100,,,fee schedule,100% of APC rate,0.07,100,,,fee schedule,100% of APC rate,0.07,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.07,100,,,fee schedule,100% of APC rate,0.07,100,,,fee schedule,100% of APC rate,0.07,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.32,40,,25.86,percent of total billed charges,40% of total billed charges,0.07,64.64,
JUGGERKNOT DRILL,5801832,CDM,272,RC,,,Outpatient,,,205,164.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164,80,,131.2,percent of total billed charges,80% of total billed charges,76.4,37.27,,61.12,percent of total billed charges,37.27% of total billed charges,76.4,37.27,,61.12,percent of total billed charges,37.27% of total billed charges,76.4,37.27,,61.12,percent of total billed charges,37.27% 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,82,40,,65.6,percent of total billed charges,40% of total billed charges,76.4,164,
JUGGERKNOT SOFT ANCH,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,748,598.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,598.4,80,,478.72,percent of total billed charges,80% of total billed charges,278.78,37.27,,223.02,percent of total billed charges,37.27% of total billed charges,278.78,37.27,,223.02,percent of total billed charges,37.27% of total billed charges,278.78,37.27,,223.02,percent of total billed charges,37.27% 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,299.2,40,,239.36,percent of total billed charges,40% of total billed charges,278.78,598.4,
MAXCORE 14G BIO GUN,5801832,CDM,272,RC,,,Outpatient,,,116,92.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,92.8,80,,74.24,percent of total billed charges,80% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% of total billed charges,43.23,37.27,,34.58,percent of total billed charges,37.27% 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,46.4,40,,37.12,percent of total billed charges,40% of total billed charges,43.23,92.8,
US VENOUS MAP UNILAT,6012447,CDM,921,RC,93986,HCPCS,Outpatient,,,186,148.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,148.8,80,,119.04,percent of total billed charges,80% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,69.32,37.27,,55.46,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,155.98,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,40,,59.52,percent of total billed charges,40% of total billed charges,69.32,155.98,
NM CARDIA STR SUPERV,7650062,CDM,482,RC,93016,HCPCS,Outpatient,,,2500,2000.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2000,80,,1600,percent of total billed charges,80% of total billed charges,931.75,37.27,,745.4,percent of total billed charges,37.27% of total billed charges,931.75,37.27,,745.4,percent of total billed charges,37.27% of total billed charges,931.75,37.27,,745.4,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.03,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1000,40,,800,percent of total billed charges,40% of total billed charges,29.03,2000,
NEPRO 1.8 CAL,6400014,CDM,250,RC,,,Outpatient,,,12.9,10.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.32,80,,8.26,percent of total billed charges,80% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% of total billed charges,4.81,37.27,,3.85,percent of total billed charges,37.27% 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,5.16,40,,4.13,percent of total billed charges,40% of total billed charges,4.81,10.32,
FAC CHG 99202 NEW PT,5612353,CDM,510,RC,99202,HCPCS,Outpatient,,,168,134.40,  ,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.21,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,62.61,134.4,
FAC CHG 99203 NEW PT,5612353,CDM,510,RC,99203,HCPCS,Outpatient,,,195,156.00,  ,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,156,80,,124.8,percent of total billed charges,80% of total billed charges,72.68,37.27,,58.14,percent of total billed charges,37.27% of total billed charges,72.68,37.27,,58.14,percent of total billed charges,37.27% of total billed charges,72.68,37.27,,58.14,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.81,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,72.68,156,
FAC CHG 99204 NEW PT,5612353,CDM,510,RC,99204,HCPCS,Outpatient,,,225,180.00,  ,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,180,80,,144,percent of total billed charges,80% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,186.51,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,83.86,186.51,
FAC CHG 99205 NEW PT,5612353,CDM,510,RC,99205,HCPCS,Outpatient,,,255,204.00,  ,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,204,80,,163.2,percent of total billed charges,80% of total billed charges,95.04,37.27,,76.03,percent of total billed charges,37.27% of total billed charges,95.04,37.27,,76.03,percent of total billed charges,37.27% of total billed charges,95.04,37.27,,76.03,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,253.53,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,95.04,253.53,
FAC CHG 99211 EST PT,5612353,CDM,510,RC,99211,HCPCS,Outpatient,,,50,40.00,  ,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.19,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,12.19,96.04,
FAC CHG 99212 EST PT,5612353,CDM,510,RC,99212,HCPCS,Outpatient,,,78,62.40,  ,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,62.4,80,,49.92,percent of total billed charges,80% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,29.07,37.27,,23.26,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.36,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,29.07,96.04,
INTUBATION SET,5801832,CDM,272,RC,,,Outpatient,,,236,188.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.8,80,,151.04,percent of total billed charges,80% of total billed charges,87.96,37.27,,70.37,percent of total billed charges,37.27% of total billed charges,87.96,37.27,,70.37,percent of total billed charges,37.27% of total billed charges,87.96,37.27,,70.37,percent of total billed charges,37.27% 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,94.4,40,,75.52,percent of total billed charges,40% of total billed charges,87.96,188.8,
BREO ELLIPTAQ 100/25,5880901,CDM,637,RC,,,Outpatient,,,245.65,196.52,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196.52,80,,157.22,percent of total billed charges,80% of total billed charges,91.55,37.27,,73.24,percent of total billed charges,37.27% of total billed charges,91.55,37.27,,73.24,percent of total billed charges,37.27% of total billed charges,91.55,37.27,,73.24,percent of total billed charges,37.27% 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,98.26,40,,78.61,percent of total billed charges,40% of total billed charges,91.55,196.52,
HEMICAP 9.5TAPERPOST,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,846,676.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,676.8,80,,541.44,percent of total billed charges,80% of total billed charges,315.3,37.27,,252.24,percent of total billed charges,37.27% of total billed charges,315.3,37.27,,252.24,percent of total billed charges,37.27% of total billed charges,315.3,37.27,,252.24,percent of total billed charges,37.27% 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,338.4,40,,270.72,percent of total billed charges,40% of total billed charges,315.3,676.8,
HEMICAP 15 ARTICULAR,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4928,3942.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3942.4,80,,3153.92,percent of total billed charges,80% of total billed charges,1836.67,37.27,,1469.34,percent of total billed charges,37.27% of total billed charges,1836.67,37.27,,1469.34,percent of total billed charges,37.27% of total billed charges,1836.67,37.27,,1469.34,percent of total billed charges,37.27% 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,1971.2,40,,1576.96,percent of total billed charges,40% of total billed charges,1836.67,3942.4,
PHALANFEAL FIXATION,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1692,1353.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1353.6,80,,1082.88,percent of total billed charges,80% of total billed charges,630.61,37.27,,504.49,percent of total billed charges,37.27% of total billed charges,630.61,37.27,,504.49,percent of total billed charges,37.27% of total billed charges,630.61,37.27,,504.49,percent of total billed charges,37.27% 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,676.8,40,,541.44,percent of total billed charges,40% of total billed charges,630.61,1353.6,
PHALANGEAL INSERT,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4082,3265.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3265.6,80,,2612.48,percent of total billed charges,80% of total billed charges,1521.36,37.27,,1217.09,percent of total billed charges,37.27% of total billed charges,1521.36,37.27,,1217.09,percent of total billed charges,37.27% of total billed charges,1521.36,37.27,,1217.09,percent of total billed charges,37.27% 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,1632.8,40,,1306.24,percent of total billed charges,40% of total billed charges,1521.36,3265.6,
RESOLUTION CLIP 235C,5801832,CDM,272,RC,,,Outpatient,,,365,292.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,292,80,,233.6,percent of total billed charges,80% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% of total billed charges,136.04,37.27,,108.83,percent of total billed charges,37.27% 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,146,40,,116.8,percent of total billed charges,40% of total billed charges,136.04,292,
ANA COMP PLUS PROFIL,7012032,CDM,300,RC,,,Outpatient,,,183,146.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,146.4,80,,117.12,percent of total billed charges,80% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% of total billed charges,68.2,37.27,,54.56,percent of total billed charges,37.27% 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,73.2,40,,58.56,percent of total billed charges,40% of total billed charges,68.2,146.4,
REMDESIVIR 1MG X100,6065130,CDM,636,RC,J0248,HCPCS,Outpatient,,,24.96,19.97,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.97,80,,15.98,percent of total billed charges,80% of total billed charges,9.3,37.27,,7.44,percent of total billed charges,37.27% of total billed charges,9.3,37.27,,7.44,percent of total billed charges,37.27% of total billed charges,9.3,37.27,,7.44,percent of total billed charges,37.27% of total billed charges,6.35,100,,,fee schedule,100% of APC rate,6.35,100,,,fee schedule,100% of APC rate,6.35,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,6.35,100,,,fee schedule,100% of APC rate,6.35,100,,,fee schedule,100% of APC rate,6.35,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.98,40,,7.98,percent of total billed charges,40% of total billed charges,6.35,19.97,
SUBOXONE 8-2MG,6400014,CDM,250,RC,,,Outpatient,,,29.3,23.44,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,23.44,80,,18.75,percent of total billed charges,80% of total billed charges,10.92,37.27,,8.74,percent of total billed charges,37.27% of total billed charges,10.92,37.27,,8.74,percent of total billed charges,37.27% of total billed charges,10.92,37.27,,8.74,percent of total billed charges,37.27% 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,11.72,40,,9.38,percent of total billed charges,40% of total billed charges,10.92,23.44,
LUVOX E.R. 100MG,5880901,CDM,637,RC,,,Outpatient,,,34.7,27.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,27.76,80,,22.21,percent of total billed charges,80% of total billed charges,12.93,37.27,,10.34,percent of total billed charges,37.27% of total billed charges,12.93,37.27,,10.34,percent of total billed charges,37.27% of total billed charges,12.93,37.27,,10.34,percent of total billed charges,37.27% 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,13.88,40,,11.1,percent of total billed charges,40% of total billed charges,12.93,27.76,
METHYLPHENIDATE SERU,7000029,CDM,301,RC,80360,HCPCS,Outpatient,,,325,260.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260,80,,208,percent of total billed charges,80% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% 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,130,40,,104,percent of total billed charges,40% of total billed charges,121.13,260,
CONCAVE REAMER 016,5801832,CDM,272,RC,,,Outpatient,,,1254,1003.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1003.2,80,,802.56,percent of total billed charges,80% of total billed charges,467.37,37.27,,373.9,percent of total billed charges,37.27% of total billed charges,467.37,37.27,,373.9,percent of total billed charges,37.27% of total billed charges,467.37,37.27,,373.9,percent of total billed charges,37.27% 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,501.6,40,,401.28,percent of total billed charges,40% of total billed charges,467.37,1003.2,
IMP SCREW 3.5MM1,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,347,277.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% 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,138.8,40,,111.04,percent of total billed charges,40% of total billed charges,129.33,277.6,
IMP SCREW 3.5M22,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,347,277.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% 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,138.8,40,,111.04,percent of total billed charges,40% of total billed charges,129.33,277.6,
DRILL BIT 2.0MM ANCH,5801832,CDM,272,RC,,,Outpatient,,,400,320.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,320,80,,256,percent of total billed charges,80% of total billed charges,149.08,37.27,,119.26,percent of total billed charges,37.27% of total billed charges,149.08,37.27,,119.26,percent of total billed charges,37.27% of total billed charges,149.08,37.27,,119.26,percent of total billed charges,37.27% 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,160,40,,128,percent of total billed charges,40% of total billed charges,149.08,320,
SPEAR JUVENILE FLAT,5801832,CDM,272,RC,C1713,HCPCS,Outpatient,,,16,12.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.8,80,,10.24,percent of total billed charges,80% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% of total billed charges,5.96,37.27,,4.77,percent of total billed charges,37.27% 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,6.4,40,,5.12,percent of total billed charges,40% of total billed charges,5.96,12.8,
IMP HAMMERTOE MD,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3045,2436.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2436,80,,1948.8,percent of total billed charges,80% of total billed charges,1134.87,37.27,,907.9,percent of total billed charges,37.27% of total billed charges,1134.87,37.27,,907.9,percent of total billed charges,37.27% of total billed charges,1134.87,37.27,,907.9,percent of total billed charges,37.27% 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,1218,40,,974.4,percent of total billed charges,40% of total billed charges,1134.87,2436,
IMP HAMMERTOE SM,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3045,2436.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2436,80,,1948.8,percent of total billed charges,80% of total billed charges,1134.87,37.27,,907.9,percent of total billed charges,37.27% of total billed charges,1134.87,37.27,,907.9,percent of total billed charges,37.27% of total billed charges,1134.87,37.27,,907.9,percent of total billed charges,37.27% 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,1218,40,,974.4,percent of total billed charges,40% of total billed charges,1134.87,2436,
IMP SCREW LOCK 3.5,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,502,401.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,401.6,80,,321.28,percent of total billed charges,80% of total billed charges,187.1,37.27,,149.68,percent of total billed charges,37.27% of total billed charges,187.1,37.27,,149.68,percent of total billed charges,37.27% of total billed charges,187.1,37.27,,149.68,percent of total billed charges,37.27% 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,200.8,40,,160.64,percent of total billed charges,40% of total billed charges,187.1,401.6,
IMP SCREW LOCK3.5/14,8605396,CDM,278,RC,,,Outpatient,,,502,401.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,401.6,80,,321.28,percent of total billed charges,80% of total billed charges,187.1,37.27,,149.68,percent of total billed charges,37.27% of total billed charges,187.1,37.27,,149.68,percent of total billed charges,37.27% of total billed charges,187.1,37.27,,149.68,percent of total billed charges,37.27% 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,200.8,40,,160.64,percent of total billed charges,40% of total billed charges,187.1,401.6,
IMP PLATE MTP LT,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3604,2883.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2883.2,80,,2306.56,percent of total billed charges,80% of total billed charges,1343.21,37.27,,1074.57,percent of total billed charges,37.27% of total billed charges,1343.21,37.27,,1074.57,percent of total billed charges,37.27% of total billed charges,1343.21,37.27,,1074.57,percent of total billed charges,37.27% 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,1441.6,40,,1153.28,percent of total billed charges,40% of total billed charges,1343.21,2883.2,
IMP PLATE UTI L0,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3000,2400.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2400,80,,1920,percent of total billed charges,80% of total billed charges,1118.1,37.27,,894.48,percent of total billed charges,37.27% of total billed charges,1118.1,37.27,,894.48,percent of total billed charges,37.27% of total billed charges,1118.1,37.27,,894.48,percent of total billed charges,37.27% 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,1200,40,,960,percent of total billed charges,40% of total billed charges,1118.1,2400,
IMP PLATE UTI SH,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3000,2400.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2400,80,,1920,percent of total billed charges,80% of total billed charges,1118.1,37.27,,894.48,percent of total billed charges,37.27% of total billed charges,1118.1,37.27,,894.48,percent of total billed charges,37.27% of total billed charges,1118.1,37.27,,894.48,percent of total billed charges,37.27% 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,1200,40,,960,percent of total billed charges,40% of total billed charges,1118.1,2400,
EAR TUBE BOBBIN VENT,8605396,CDM,278,RC,,,Outpatient,,,73,58.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58.4,80,,46.72,percent of total billed charges,80% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% of total billed charges,27.21,37.27,,21.77,percent of total billed charges,37.27% 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,29.2,40,,23.36,percent of total billed charges,40% of total billed charges,27.21,58.4,
CONVEX REAMER 016,5801832,CDM,272,RC,,,Outpatient,,,1254,1003.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1003.2,80,,802.56,percent of total billed charges,80% of total billed charges,467.37,37.27,,373.9,percent of total billed charges,37.27% of total billed charges,467.37,37.27,,373.9,percent of total billed charges,37.27% of total billed charges,467.37,37.27,,373.9,percent of total billed charges,37.27% 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,501.6,40,,401.28,percent of total billed charges,40% of total billed charges,467.37,1003.2,
IMP TOE PHALAG 2.5M,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4082,3265.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3265.6,80,,2612.48,percent of total billed charges,80% of total billed charges,1521.36,37.27,,1217.09,percent of total billed charges,37.27% of total billed charges,1521.36,37.27,,1217.09,percent of total billed charges,37.27% of total billed charges,1521.36,37.27,,1217.09,percent of total billed charges,37.27% 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,1632.8,40,,1306.24,percent of total billed charges,40% of total billed charges,1521.36,3265.6,
IMP TOE TAPER 9.5MM,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,846,676.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,676.8,80,,541.44,percent of total billed charges,80% of total billed charges,315.3,37.27,,252.24,percent of total billed charges,37.27% of total billed charges,315.3,37.27,,252.24,percent of total billed charges,37.27% of total billed charges,315.3,37.27,,252.24,percent of total billed charges,37.27% 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,338.4,40,,270.72,percent of total billed charges,40% of total billed charges,315.3,676.8,
IMP TOE HEMICAP 15M,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4928,3942.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3942.4,80,,3153.92,percent of total billed charges,80% of total billed charges,1836.67,37.27,,1469.34,percent of total billed charges,37.27% of total billed charges,1836.67,37.27,,1469.34,percent of total billed charges,37.27% of total billed charges,1836.67,37.27,,1469.34,percent of total billed charges,37.27% 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,1971.2,40,,1576.96,percent of total billed charges,40% of total billed charges,1836.67,3942.4,
IMP SCRW NCK 3.5/38,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,347,277.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% 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,138.8,40,,111.04,percent of total billed charges,40% of total billed charges,129.33,277.6,
IMP SCW NCKC3.5/18,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,347,277.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% 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,138.8,40,,111.04,percent of total billed charges,40% of total billed charges,129.33,277.6,
IMP SCW NCK 3.5/16,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,347,277.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% 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,138.8,40,,111.04,percent of total billed charges,40% of total billed charges,129.33,277.6,
IMP SCW NLCK 3.5/10M,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,347,277.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% 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,138.8,40,,111.04,percent of total billed charges,40% of total billed charges,129.33,277.6,
INTUBATION SET,8605396,CDM,278,RC,,,Outpatient,,,347,277.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,277.6,80,,222.08,percent of total billed charges,80% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% of total billed charges,129.33,37.27,,103.46,percent of total billed charges,37.27% 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,138.8,40,,111.04,percent of total billed charges,40% of total billed charges,129.33,277.6,
DISULFIRAM 250MG,6400014,CDM,250,RC,,,Outpatient,,,13.75,11.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11,80,,8.8,percent of total billed charges,80% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% of total billed charges,5.12,37.27,,4.1,percent of total billed charges,37.27% 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,5.5,40,,4.4,percent of total billed charges,40% of total billed charges,5.12,11,
K WIRE 451-1136,5801832,CDM,272,RC,C1713,HCPCS,Outpatient,,,64,51.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,51.2,80,,40.96,percent of total billed charges,80% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% of total billed charges,23.85,37.27,,19.08,percent of total billed charges,37.27% 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,25.6,40,,20.48,percent of total billed charges,40% of total billed charges,23.85,51.2,
SCREW AUTOFIX 3.0X14,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,392,313.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,313.6,80,,250.88,percent of total billed charges,80% of total billed charges,146.1,37.27,,116.88,percent of total billed charges,37.27% of total billed charges,146.1,37.27,,116.88,percent of total billed charges,37.27% of total billed charges,146.1,37.27,,116.88,percent of total billed charges,37.27% 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,156.8,40,,125.44,percent of total billed charges,40% of total billed charges,146.1,313.6,
IMP HAMMERTOE MD,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3806,3044.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3044.8,80,,2435.84,percent of total billed charges,80% of total billed charges,1418.5,37.27,,1134.8,percent of total billed charges,37.27% of total billed charges,1418.5,37.27,,1134.8,percent of total billed charges,37.27% of total billed charges,1418.5,37.27,,1134.8,percent of total billed charges,37.27% 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,1522.4,40,,1217.92,percent of total billed charges,40% of total billed charges,1418.5,3044.8,
SCREW AUTOFIX 11X16,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,525,420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420,80,,336,percent of total billed charges,80% of total billed charges,195.67,37.27,,156.54,percent of total billed charges,37.27% of total billed charges,195.67,37.27,,156.54,percent of total billed charges,37.27% of total billed charges,195.67,37.27,,156.54,percent of total billed charges,37.27% 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,210,40,,168,percent of total billed charges,40% of total billed charges,195.67,420,
SCREW AUTOFIX 11X40,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,525,420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420,80,,336,percent of total billed charges,80% of total billed charges,195.67,37.27,,156.54,percent of total billed charges,37.27% of total billed charges,195.67,37.27,,156.54,percent of total billed charges,37.27% of total billed charges,195.67,37.27,,156.54,percent of total billed charges,37.27% 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,210,40,,168,percent of total billed charges,40% of total billed charges,195.67,420,
SCREW AUTOFIX 3X34,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,525,420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420,80,,336,percent of total billed charges,80% of total billed charges,195.67,37.27,,156.54,percent of total billed charges,37.27% of total billed charges,195.67,37.27,,156.54,percent of total billed charges,37.27% of total billed charges,195.67,37.27,,156.54,percent of total billed charges,37.27% 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,210,40,,168,percent of total billed charges,40% of total billed charges,195.67,420,
COUNTERSINK,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,761,608.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,608.8,80,,487.04,percent of total billed charges,80% of total billed charges,283.62,37.27,,226.9,percent of total billed charges,37.27% of total billed charges,283.62,37.27,,226.9,percent of total billed charges,37.27% of total billed charges,283.62,37.27,,226.9,percent of total billed charges,37.27% 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,304.4,40,,243.52,percent of total billed charges,40% of total billed charges,283.62,608.8,
SCREW AUTOFIX 3.0X18,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,525,420.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420,80,,336,percent of total billed charges,80% of total billed charges,195.67,37.27,,156.54,percent of total billed charges,37.27% of total billed charges,195.67,37.27,,156.54,percent of total billed charges,37.27% of total billed charges,195.67,37.27,,156.54,percent of total billed charges,37.27% 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,210,40,,168,percent of total billed charges,40% of total billed charges,195.67,420,
SCREW AUTOFIX 4.0X48,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,579,463.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,463.2,80,,370.56,percent of total billed charges,80% of total billed charges,215.79,37.27,,172.63,percent of total billed charges,37.27% of total billed charges,215.79,37.27,,172.63,percent of total billed charges,37.27% of total billed charges,215.79,37.27,,172.63,percent of total billed charges,37.27% 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,231.6,40,,185.28,percent of total billed charges,40% of total billed charges,215.79,463.2,
SCREW AUTOFIX 4.0X40,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,458,366.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,366.4,80,,293.12,percent of total billed charges,80% of total billed charges,170.7,37.27,,136.56,percent of total billed charges,37.27% of total billed charges,170.7,37.27,,136.56,percent of total billed charges,37.27% of total billed charges,170.7,37.27,,136.56,percent of total billed charges,37.27% 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,183.2,40,,146.56,percent of total billed charges,40% of total billed charges,170.7,366.4,
OPCE DIRET ADMIT TEL,8399990,CDM,762,RC,G0379,HCPCS,Outpatient,,,1300,1040.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1040,80,,832,percent of total billed charges,80% of total billed charges,484.51,37.27,,387.61,percent of total billed charges,37.27% of total billed charges,484.51,37.27,,387.61,percent of total billed charges,37.27% of total billed charges,484.51,37.27,,387.61,percent of total billed charges,37.27% of total billed charges,529.59,100,,,fee schedule,100% of APC rate,529.59,100,,,fee schedule,100% of APC rate,529.59,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,529.59,100,,,fee schedule,100% of APC rate,529.59,100,,,fee schedule,100% of APC rate,529.59,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520,40,,416,percent of total billed charges,40% of total billed charges,484.51,1040,
MICAFUNGIN 100MG,6065130,CDM,636,RC,J2248,HCPCS,Outpatient,,,7.65,6.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.12,80,,4.9,percent of total billed charges,80% of total billed charges,2.85,37.27,,2.28,percent of total billed charges,37.27% of total billed charges,2.85,37.27,,2.28,percent of total billed charges,37.27% of total billed charges,2.85,37.27,,2.28,percent of total billed charges,37.27% 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,3.06,40,,2.45,percent of total billed charges,40% of total billed charges,2.85,6.12,
CT ENTEROGRAPHY,6010052,CDM,350,RC,74178,HCPCS,Outpatient,,,3564,2851.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,324.68,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,317.08,2851.2,
PRECEDEX INJ 200MCG,6065130,CDM,636,RC,,,Outpatient,,,175.95,140.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.76,80,,112.61,percent of total billed charges,80% of total billed charges,65.58,37.27,,52.46,percent of total billed charges,37.27% of total billed charges,65.58,37.27,,52.46,percent of total billed charges,37.27% of total billed charges,65.58,37.27,,52.46,percent of total billed charges,37.27% 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,70.38,40,,56.3,percent of total billed charges,40% of total billed charges,65.58,140.76,
ENTEREG,5880901,CDM,637,RC,,,Outpatient,,,632.8,506.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,506.24,80,,404.99,percent of total billed charges,80% of total billed charges,235.84,37.27,,188.67,percent of total billed charges,37.27% of total billed charges,235.84,37.27,,188.67,percent of total billed charges,37.27% of total billed charges,235.84,37.27,,188.67,percent of total billed charges,37.27% 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,253.12,40,,202.5,percent of total billed charges,40% of total billed charges,235.84,506.24,
SPLINT RESTING HAND,5645742,CDM,270,RC,,,Outpatient,,,150,120.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% 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,60,40,,48,percent of total billed charges,40% of total billed charges,55.91,120,
I-123 ISOTOPE,6071625,CDM,343,RC,A9582,HCPCS,Outpatient,,,175,140.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140,80,,112,percent of total billed charges,80% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% 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,70,40,,56,percent of total billed charges,40% of total billed charges,65.22,140,
INDOCYANINE GREEN,6065130,CDM,636,RC,,,Outpatient,,,766.6,613.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,613.28,80,,490.62,percent of total billed charges,80% of total billed charges,285.71,37.27,,228.57,percent of total billed charges,37.27% of total billed charges,285.71,37.27,,228.57,percent of total billed charges,37.27% of total billed charges,285.71,37.27,,228.57,percent of total billed charges,37.27% 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,306.64,40,,245.31,percent of total billed charges,40% of total billed charges,285.71,613.28,
CT MAXFAC SIN W/WO,6010052,CDM,350,RC,70488,HCPCS,Outpatient,,,1895,1516.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1516,80,,1212.8,percent of total billed charges,80% of total billed charges,706.27,37.27,,565.02,percent of total billed charges,37.27% of total billed charges,706.27,37.27,,565.02,percent of total billed charges,37.27% of total billed charges,706.27,37.27,,565.02,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,164.73,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,758,40,,606.4,percent of total billed charges,40% of total billed charges,151.49,1516,
DRILL BIT QC1.5X85MM,5801832,CDM,272,RC,,,Outpatient,,,388,310.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% 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,155.2,40,,124.16,percent of total billed charges,40% of total billed charges,144.61,310.4,
SCR CORT S/T 2.0X10M,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,293,234.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.4,80,,187.52,percent of total billed charges,80% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% 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,117.2,40,,93.76,percent of total billed charges,40% of total billed charges,109.2,234.4,
SCR COR S/T 2.0X11MM,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,293,234.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,234.4,80,,187.52,percent of total billed charges,80% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% of total billed charges,109.2,37.27,,87.36,percent of total billed charges,37.27% 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,117.2,40,,93.76,percent of total billed charges,40% of total billed charges,109.2,234.4,
IMP CEMENT SPACER,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,250,200.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200,80,,160,percent of total billed charges,80% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% of total billed charges,93.18,37.27,,74.54,percent of total billed charges,37.27% 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,100,40,,80,percent of total billed charges,40% of total billed charges,93.18,200,
IMP ALLOGRAFT 4X8,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5414,4331.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4331.2,80,,3464.96,percent of total billed charges,80% of total billed charges,2017.8,37.27,,1614.24,percent of total billed charges,37.27% of total billed charges,2017.8,37.27,,1614.24,percent of total billed charges,37.27% of total billed charges,2017.8,37.27,,1614.24,percent of total billed charges,37.27% 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,2165.6,40,,1732.48,percent of total billed charges,40% of total billed charges,2017.8,4331.2,
US BIO PHY NON FETAL,6000566,CDM,402,RC,76819,HCPCS,Outpatient,,,450,360.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360,80,,288,percent of total billed charges,80% of total billed charges,167.72,37.27,,134.18,percent of total billed charges,37.27% of total billed charges,167.72,37.27,,134.18,percent of total billed charges,37.27% of total billed charges,167.72,37.27,,134.18,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,63.25,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,40,,144,percent of total billed charges,40% of total billed charges,63.25,360,
ACETABU SHELL56M,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2500,2000.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2000,80,,1600,percent of total billed charges,80% of total billed charges,931.75,37.27,,745.4,percent of total billed charges,37.27% of total billed charges,931.75,37.27,,745.4,percent of total billed charges,37.27% of total billed charges,931.75,37.27,,745.4,percent of total billed charges,37.27% 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,1000,40,,800,percent of total billed charges,40% of total billed charges,931.75,2000,
IMP ACETLINER 36X56,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,1250,1000.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1000,80,,800,percent of total billed charges,80% of total billed charges,465.88,37.27,,372.7,percent of total billed charges,37.27% of total billed charges,465.88,37.27,,372.7,percent of total billed charges,37.27% of total billed charges,465.88,37.27,,372.7,percent of total billed charges,37.27% 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,500,40,,400,percent of total billed charges,40% of total billed charges,465.88,1000,
IMP SCREW CAN 6.5X25,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,150,120.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% 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,60,40,,48,percent of total billed charges,40% of total billed charges,55.91,120,
IMP FEMORAL STEM 5,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2108,1686.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1686.4,80,,1349.12,percent of total billed charges,80% of total billed charges,785.65,37.27,,628.52,percent of total billed charges,37.27% of total billed charges,785.65,37.27,,628.52,percent of total billed charges,37.27% of total billed charges,785.65,37.27,,628.52,percent of total billed charges,37.27% 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,843.2,40,,674.56,percent of total billed charges,40% of total billed charges,785.65,1686.4,
IMP FEMORAL HEAD 36M,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,1353,1082.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1082.4,80,,865.92,percent of total billed charges,80% of total billed charges,504.26,37.27,,403.41,percent of total billed charges,37.27% of total billed charges,504.26,37.27,,403.41,percent of total billed charges,37.27% of total billed charges,504.26,37.27,,403.41,percent of total billed charges,37.27% 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,541.2,40,,432.96,percent of total billed charges,40% of total billed charges,504.26,1082.4,
MESH VENTR HERNIA S,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,1001,800.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,800.8,80,,640.64,percent of total billed charges,80% of total billed charges,373.07,37.27,,298.46,percent of total billed charges,37.27% of total billed charges,373.07,37.27,,298.46,percent of total billed charges,37.27% of total billed charges,373.07,37.27,,298.46,percent of total billed charges,37.27% 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,400.4,40,,320.32,percent of total billed charges,40% of total billed charges,373.07,800.8,
MESH VENTRA HERINA M,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,1202,961.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,961.6,80,,769.28,percent of total billed charges,80% of total billed charges,447.99,37.27,,358.39,percent of total billed charges,37.27% of total billed charges,447.99,37.27,,358.39,percent of total billed charges,37.27% of total billed charges,447.99,37.27,,358.39,percent of total billed charges,37.27% 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,480.8,40,,384.64,percent of total billed charges,40% of total billed charges,447.99,961.6,
IMP HIP STEM 6098-05,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2625,2100.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2100,80,,1680,percent of total billed charges,80% of total billed charges,978.34,37.27,,782.67,percent of total billed charges,37.27% of total billed charges,978.34,37.27,,782.67,percent of total billed charges,37.27% of total billed charges,978.34,37.27,,782.67,percent of total billed charges,37.27% 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,1050,40,,840,percent of total billed charges,40% of total billed charges,978.34,2100,
IMP HEAD UH1-48-28,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,875,700.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,700,80,,560,percent of total billed charges,80% of total billed charges,326.11,37.27,,260.89,percent of total billed charges,37.27% of total billed charges,326.11,37.27,,260.89,percent of total billed charges,37.27% of total billed charges,326.11,37.27,,260.89,percent of total billed charges,37.27% 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,350,40,,280,percent of total billed charges,40% of total billed charges,326.11,700,
IMP HEAD 06-2898,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,790,632.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,632,80,,505.6,percent of total billed charges,80% of total billed charges,294.43,37.27,,235.54,percent of total billed charges,37.27% of total billed charges,294.43,37.27,,235.54,percent of total billed charges,37.27% of total billed charges,294.43,37.27,,235.54,percent of total billed charges,37.27% 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,316,40,,252.8,percent of total billed charges,40% of total billed charges,294.43,632,
IMP CEMENT 1067-0014,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,175,140.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140,80,,112,percent of total billed charges,80% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% 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,70,40,,56,percent of total billed charges,40% of total billed charges,65.22,140,
CEMENT BONE STRYKER,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,475,380.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380,80,,304,percent of total billed charges,80% of total billed charges,177.03,37.27,,141.62,percent of total billed charges,37.27% of total billed charges,177.03,37.27,,141.62,percent of total billed charges,37.27% of total billed charges,177.03,37.27,,141.62,percent of total billed charges,37.27% 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,190,40,,152,percent of total billed charges,40% of total billed charges,177.03,380,
STRYKER COUNTERSINK,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,670,536.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,536,80,,428.8,percent of total billed charges,80% of total billed charges,249.71,37.27,,199.77,percent of total billed charges,37.27% of total billed charges,249.71,37.27,,199.77,percent of total billed charges,37.27% of total billed charges,249.71,37.27,,199.77,percent of total billed charges,37.27% 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,268,40,,214.4,percent of total billed charges,40% of total billed charges,249.71,536,
IMP SCREW 4X38 141-4,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,510,408.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,408,80,,326.4,percent of total billed charges,80% of total billed charges,190.08,37.27,,152.06,percent of total billed charges,37.27% of total billed charges,190.08,37.27,,152.06,percent of total billed charges,37.27% of total billed charges,190.08,37.27,,152.06,percent of total billed charges,37.27% 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,204,40,,163.2,percent of total billed charges,40% of total billed charges,190.08,408,
IMP SCREW 2X14 141-2,8605396,CDM,278,RC,,,Outpatient,,,556,444.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,444.8,80,,355.84,percent of total billed charges,80% of total billed charges,207.22,37.27,,165.78,percent of total billed charges,37.27% of total billed charges,207.22,37.27,,165.78,percent of total billed charges,37.27% of total billed charges,207.22,37.27,,165.78,percent of total billed charges,37.27% 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,222.4,40,,177.92,percent of total billed charges,40% of total billed charges,207.22,444.8,
IMP HAMERTOE HT00002,8605396,CDM,278,RC,,,Outpatient,,,2665,2132.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2132,80,,1705.6,percent of total billed charges,80% of total billed charges,993.25,37.27,,794.6,percent of total billed charges,37.27% of total billed charges,993.25,37.27,,794.6,percent of total billed charges,37.27% of total billed charges,993.25,37.27,,794.6,percent of total billed charges,37.27% 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,1066,40,,852.8,percent of total billed charges,40% of total billed charges,993.25,2132,
IMP SCREW 3X26 14130,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,460,368.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,368,80,,294.4,percent of total billed charges,80% of total billed charges,171.44,37.27,,137.15,percent of total billed charges,37.27% of total billed charges,171.44,37.27,,137.15,percent of total billed charges,37.27% of total billed charges,171.44,37.27,,137.15,percent of total billed charges,37.27% 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,184,40,,147.2,percent of total billed charges,40% of total billed charges,171.44,368,
IMP COUNTERSINK 9070,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,820,656.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,656,80,,524.8,percent of total billed charges,80% of total billed charges,305.61,37.27,,244.49,percent of total billed charges,37.27% of total billed charges,305.61,37.27,,244.49,percent of total billed charges,37.27% of total billed charges,305.61,37.27,,244.49,percent of total billed charges,37.27% 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,328,40,,262.4,percent of total billed charges,40% of total billed charges,305.61,656,
IMP SCREW 3X38 14130,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,398,318.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% 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,159.2,40,,127.36,percent of total billed charges,40% of total billed charges,148.33,318.4,
IMP SCREW 3X30 14130,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,398,318.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,318.4,80,,254.72,percent of total billed charges,80% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% of total billed charges,148.33,37.27,,118.66,percent of total billed charges,37.27% 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,159.2,40,,127.36,percent of total billed charges,40% of total billed charges,148.33,318.4,
STRYKER GUIDE 703386,5801832,CDM,272,RC,,,Outpatient,,,884,707.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,707.2,80,,565.76,percent of total billed charges,80% of total billed charges,329.47,37.27,,263.58,percent of total billed charges,37.27% of total billed charges,329.47,37.27,,263.58,percent of total billed charges,37.27% of total billed charges,329.47,37.27,,263.58,percent of total billed charges,37.27% 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,353.6,40,,282.88,percent of total billed charges,40% of total billed charges,329.47,707.2,
STRYKER DRILL BIT 70,8605396,CDM,278,RC,,,Outpatient,,,467,373.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,373.6,80,,298.88,percent of total billed charges,80% of total billed charges,174.05,37.27,,139.24,percent of total billed charges,37.27% of total billed charges,174.05,37.27,,139.24,percent of total billed charges,37.27% of total billed charges,174.05,37.27,,139.24,percent of total billed charges,37.27% 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,186.8,40,,149.44,percent of total billed charges,40% of total billed charges,174.05,373.6,
K WIRE 702492,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,100,80.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% 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,40,40,,32,percent of total billed charges,40% of total billed charges,37.27,80,
STRYKER DRILL BIT 70,8605396,CDM,278,RC,,,Outpatient,,,715,572.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,572,80,,457.6,percent of total billed charges,80% of total billed charges,266.48,37.27,,213.18,percent of total billed charges,37.27% of total billed charges,266.48,37.27,,213.18,percent of total billed charges,37.27% of total billed charges,266.48,37.27,,213.18,percent of total billed charges,37.27% 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,286,40,,228.8,percent of total billed charges,40% of total billed charges,266.48,572,
IMP PLATE 4H 4020904,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1373,1098.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1098.4,80,,878.72,percent of total billed charges,80% of total billed charges,511.72,37.27,,409.38,percent of total billed charges,37.27% of total billed charges,511.72,37.27,,409.38,percent of total billed charges,37.27% of total billed charges,511.72,37.27,,409.38,percent of total billed charges,37.27% 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,549.2,40,,439.36,percent of total billed charges,40% of total billed charges,511.72,1098.4,
IMP SCREW 3.5X14 657,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,211,168.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.8,80,,135.04,percent of total billed charges,80% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% 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,84.4,40,,67.52,percent of total billed charges,40% of total billed charges,78.64,168.8,
IMP SCREW 3.5X50 657,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,211,168.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.8,80,,135.04,percent of total billed charges,80% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% 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,84.4,40,,67.52,percent of total billed charges,40% of total billed charges,78.64,168.8,
IMP SCREW 3.5X14 657,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,388,310.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% 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,155.2,40,,124.16,percent of total billed charges,40% of total billed charges,144.61,310.4,
IMP SCREW 3.5X16 657,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,388,310.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% 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,155.2,40,,124.16,percent of total billed charges,40% of total billed charges,144.61,310.4,
IMP SCREW 3.5X12 657,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,388,310.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% 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,155.2,40,,124.16,percent of total billed charges,40% of total billed charges,144.61,310.4,
IMP SCREW 4.0X44 604,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,348,278.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% 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,139.2,40,,111.36,percent of total billed charges,40% of total billed charges,129.7,278.4,
IMP SCREW 4.0X48 604,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,348,278.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% 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,139.2,40,,111.36,percent of total billed charges,40% of total billed charges,129.7,278.4,
HIP FEMORAL STEM,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2460,1968.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1968,80,,1574.4,percent of total billed charges,80% of total billed charges,916.84,37.27,,733.47,percent of total billed charges,37.27% of total billed charges,916.84,37.27,,733.47,percent of total billed charges,37.27% of total billed charges,916.84,37.27,,733.47,percent of total billed charges,37.27% 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,984,40,,787.2,percent of total billed charges,40% of total billed charges,916.84,1968,
HIP FEMORAL HEAD 136,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,1579,1263.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1263.2,80,,1010.56,percent of total billed charges,80% of total billed charges,588.49,37.27,,470.79,percent of total billed charges,37.27% of total billed charges,588.49,37.27,,470.79,percent of total billed charges,37.27% of total billed charges,588.49,37.27,,470.79,percent of total billed charges,37.27% 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,631.6,40,,505.28,percent of total billed charges,40% of total billed charges,588.49,1263.2,
HIP ACETABULAR LINER,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,1446,1156.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1156.8,80,,925.44,percent of total billed charges,80% of total billed charges,538.92,37.27,,431.14,percent of total billed charges,37.27% of total billed charges,538.92,37.27,,431.14,percent of total billed charges,37.27% of total billed charges,538.92,37.27,,431.14,percent of total billed charges,37.27% 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,578.4,40,,462.72,percent of total billed charges,40% of total billed charges,538.92,1156.8,
HIP ACETABULAR SHELL,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2841,2272.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2272.8,80,,1818.24,percent of total billed charges,80% of total billed charges,1058.84,37.27,,847.07,percent of total billed charges,37.27% of total billed charges,1058.84,37.27,,847.07,percent of total billed charges,37.27% of total billed charges,1058.84,37.27,,847.07,percent of total billed charges,37.27% 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,1136.4,40,,909.12,percent of total billed charges,40% of total billed charges,1058.84,2272.8,
HIP CANCELLOUS SCREW,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,175,140.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140,80,,112,percent of total billed charges,80% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% of total billed charges,65.22,37.27,,52.18,percent of total billed charges,37.27% 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,70,40,,56,percent of total billed charges,40% of total billed charges,65.22,140,
IMP ALLOGRAFT 4X8,8605396,CDM,278,RC,C1762,HCPCS,Outpatient,,,4730,3784.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3784,80,,3027.2,percent of total billed charges,80% of total billed charges,1762.87,37.27,,1410.3,percent of total billed charges,37.27% of total billed charges,1762.87,37.27,,1410.3,percent of total billed charges,37.27% of total billed charges,1762.87,37.27,,1410.3,percent of total billed charges,37.27% 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,1892,40,,1513.6,percent of total billed charges,40% of total billed charges,1762.87,3784,
K WIRE 1X110 4510016,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,52,41.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% 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,20.8,40,,16.64,percent of total billed charges,40% of total billed charges,19.38,41.6,
IMP SCREW AUTOFIX,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,507,405.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,405.6,80,,324.48,percent of total billed charges,80% of total billed charges,188.96,37.27,,151.17,percent of total billed charges,37.27% of total billed charges,188.96,37.27,,151.17,percent of total billed charges,37.27% of total billed charges,188.96,37.27,,151.17,percent of total billed charges,37.27% 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,202.8,40,,162.24,percent of total billed charges,40% of total billed charges,188.96,405.6,
IMP SCREW A-FIX 3X36,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,440,352.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,352,80,,281.6,percent of total billed charges,80% of total billed charges,163.99,37.27,,131.19,percent of total billed charges,37.27% of total billed charges,163.99,37.27,,131.19,percent of total billed charges,37.27% of total billed charges,163.99,37.27,,131.19,percent of total billed charges,37.27% 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,176,40,,140.8,percent of total billed charges,40% of total billed charges,163.99,352,
MESH PROGRIP 8X12 LF,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,598,478.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,478.4,80,,382.72,percent of total billed charges,80% of total billed charges,222.87,37.27,,178.3,percent of total billed charges,37.27% of total billed charges,222.87,37.27,,178.3,percent of total billed charges,37.27% of total billed charges,222.87,37.27,,178.3,percent of total billed charges,37.27% 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,239.2,40,,191.36,percent of total billed charges,40% of total billed charges,222.87,478.4,
MESH PROGRIP 9X14 LF,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,616,492.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,492.8,80,,394.24,percent of total billed charges,80% of total billed charges,229.58,37.27,,183.66,percent of total billed charges,37.27% of total billed charges,229.58,37.27,,183.66,percent of total billed charges,37.27% of total billed charges,229.58,37.27,,183.66,percent of total billed charges,37.27% 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,246.4,40,,197.12,percent of total billed charges,40% of total billed charges,229.58,492.8,
MESH PROGRIP 9X14 RT,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,616,492.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,492.8,80,,394.24,percent of total billed charges,80% of total billed charges,229.58,37.27,,183.66,percent of total billed charges,37.27% of total billed charges,229.58,37.27,,183.66,percent of total billed charges,37.27% of total billed charges,229.58,37.27,,183.66,percent of total billed charges,37.27% 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,246.4,40,,197.12,percent of total billed charges,40% of total billed charges,229.58,492.8,
MESH PROGRIP RECT 15,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,563,450.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,450.4,80,,360.32,percent of total billed charges,80% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% 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,225.2,40,,180.16,percent of total billed charges,40% of total billed charges,209.83,450.4,
MESH PROGRIP REC 15X,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,581,464.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,464.8,80,,371.84,percent of total billed charges,80% of total billed charges,216.54,37.27,,173.23,percent of total billed charges,37.27% of total billed charges,216.54,37.27,,173.23,percent of total billed charges,37.27% of total billed charges,216.54,37.27,,173.23,percent of total billed charges,37.27% 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,232.4,40,,185.92,percent of total billed charges,40% of total billed charges,216.54,464.8,
MESH PROGRIP 8X12 RT,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,668,534.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,534.4,80,,427.52,percent of total billed charges,80% of total billed charges,248.96,37.27,,199.17,percent of total billed charges,37.27% of total billed charges,248.96,37.27,,199.17,percent of total billed charges,37.27% of total billed charges,248.96,37.27,,199.17,percent of total billed charges,37.27% 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,267.2,40,,213.76,percent of total billed charges,40% of total billed charges,248.96,534.4,
K WIRE TROCAR1.0X150,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,312,249.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% 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,124.8,40,,99.84,percent of total billed charges,40% of total billed charges,116.28,249.6,
MESH VENTRA 4.5 CIR,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,2145,1716.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1716,80,,1372.8,percent of total billed charges,80% of total billed charges,799.44,37.27,,639.55,percent of total billed charges,37.27% of total billed charges,799.44,37.27,,639.55,percent of total billed charges,37.27% of total billed charges,799.44,37.27,,639.55,percent of total billed charges,37.27% 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,858,40,,686.4,percent of total billed charges,40% of total billed charges,799.44,1716,
MESH VENTRA 4X6 ELLI,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,1653,1322.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1322.4,80,,1057.92,percent of total billed charges,80% of total billed charges,616.07,37.27,,492.86,percent of total billed charges,37.27% of total billed charges,616.07,37.27,,492.86,percent of total billed charges,37.27% of total billed charges,616.07,37.27,,492.86,percent of total billed charges,37.27% 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,661.2,40,,528.96,percent of total billed charges,40% of total billed charges,616.07,1322.4,
MESH VENTRA 6 CIRCLE,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,2544,2035.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2035.2,80,,1628.16,percent of total billed charges,80% of total billed charges,948.15,37.27,,758.52,percent of total billed charges,37.27% of total billed charges,948.15,37.27,,758.52,percent of total billed charges,37.27% of total billed charges,948.15,37.27,,758.52,percent of total billed charges,37.27% 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,1017.6,40,,814.08,percent of total billed charges,40% of total billed charges,948.15,2035.2,
MESH VENTRA 6X8 ELLI,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,3032,2425.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2425.6,80,,1940.48,percent of total billed charges,80% of total billed charges,1130.03,37.27,,904.02,percent of total billed charges,37.27% of total billed charges,1130.03,37.27,,904.02,percent of total billed charges,37.27% of total billed charges,1130.03,37.27,,904.02,percent of total billed charges,37.27% 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,1212.8,40,,970.24,percent of total billed charges,40% of total billed charges,1130.03,2425.6,
MESH VENTRA 6X10 OVA,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,3711,2968.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2968.8,80,,2375.04,percent of total billed charges,80% of total billed charges,1383.09,37.27,,1106.47,percent of total billed charges,37.27% of total billed charges,1383.09,37.27,,1106.47,percent of total billed charges,37.27% of total billed charges,1383.09,37.27,,1106.47,percent of total billed charges,37.27% 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,1484.4,40,,1187.52,percent of total billed charges,40% of total billed charges,1383.09,2968.8,
MESH VENTRA 7X9 ELLI,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,3984,3187.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3187.2,80,,2549.76,percent of total billed charges,80% of total billed charges,1484.84,37.27,,1187.87,percent of total billed charges,37.27% of total billed charges,1484.84,37.27,,1187.87,percent of total billed charges,37.27% of total billed charges,1484.84,37.27,,1187.87,percent of total billed charges,37.27% 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,1593.6,40,,1274.88,percent of total billed charges,40% of total billed charges,1484.84,3187.2,
MESH UBMILICAL TINTR,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,1488,1190.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1190.4,80,,952.32,percent of total billed charges,80% of total billed charges,554.58,37.27,,443.66,percent of total billed charges,37.27% of total billed charges,554.58,37.27,,443.66,percent of total billed charges,37.27% of total billed charges,554.58,37.27,,443.66,percent of total billed charges,37.27% 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,595.2,40,,476.16,percent of total billed charges,40% of total billed charges,554.58,1190.4,
IMP PRO TOE VO 3.2,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1225,980.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,980,80,,784,percent of total billed charges,80% of total billed charges,456.56,37.27,,365.25,percent of total billed charges,37.27% of total billed charges,456.56,37.27,,365.25,percent of total billed charges,37.27% of total billed charges,456.56,37.27,,365.25,percent of total billed charges,37.27% 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,490,40,,392,percent of total billed charges,40% of total billed charges,456.56,980,
WOUND PROT ALEXIS ME,5801832,CDM,272,RC,A4649,HCPCS,Outpatient,,,95,76.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% 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,38,40,,30.4,percent of total billed charges,40% of total billed charges,35.41,76,
WOUND PROT ALEXIS LG,5801832,CDM,272,RC,A4649,HCPCS,Outpatient,,,131,104.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% 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,52.4,40,,41.92,percent of total billed charges,40% of total billed charges,48.82,104.8,
SUTURE ANCHOR AR1920,5801832,CDM,272,RC,,,Outpatient,,,341,272.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% 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,136.4,40,,109.12,percent of total billed charges,40% of total billed charges,127.09,272.8,
NEEDLE W LOOP AR7281,5801832,CDM,272,RC,,,Outpatient,,,33,26.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% 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,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,12.3,26.4,
IMP SCREW XSM CAN 45,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1488,1190.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1190.4,80,,952.32,percent of total billed charges,80% of total billed charges,554.58,37.27,,443.66,percent of total billed charges,37.27% of total billed charges,554.58,37.27,,443.66,percent of total billed charges,37.27% of total billed charges,554.58,37.27,,443.66,percent of total billed charges,37.27% 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,595.2,40,,476.16,percent of total billed charges,40% of total billed charges,554.58,1190.4,
K WIRE 1.1X102 4530,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,131,104.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% 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,52.4,40,,41.92,percent of total billed charges,40% of total billed charges,48.82,104.8,
STRYKER GUIDE 703888,5801832,CDM,272,RC,,,Outpatient,,,695,556.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,556,80,,444.8,percent of total billed charges,80% of total billed charges,259.03,37.27,,207.22,percent of total billed charges,37.27% of total billed charges,259.03,37.27,,207.22,percent of total billed charges,37.27% of total billed charges,259.03,37.27,,207.22,percent of total billed charges,37.27% 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,278,40,,222.4,percent of total billed charges,40% of total billed charges,259.03,556,
STRYKER DRILL BIT 70,5801832,CDM,272,RC,,,Outpatient,,,362,289.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,289.6,80,,231.68,percent of total billed charges,80% of total billed charges,134.92,37.27,,107.94,percent of total billed charges,37.27% of total billed charges,134.92,37.27,,107.94,percent of total billed charges,37.27% of total billed charges,134.92,37.27,,107.94,percent of total billed charges,37.27% 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,144.8,40,,115.84,percent of total billed charges,40% of total billed charges,134.92,289.6,
IMP PLATE 40-15091,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,917,733.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,733.6,80,,586.88,percent of total billed charges,80% of total billed charges,341.77,37.27,,273.42,percent of total billed charges,37.27% of total billed charges,341.77,37.27,,273.42,percent of total billed charges,37.27% of total billed charges,341.77,37.27,,273.42,percent of total billed charges,37.27% 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,366.8,40,,293.44,percent of total billed charges,40% of total billed charges,341.77,733.6,
IMP SCREW 2.7X20,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,203,162.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% 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,81.2,40,,64.96,percent of total billed charges,40% of total billed charges,75.66,162.4,
IMP SCREW 2.7X12 656,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,203,162.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,162.4,80,,129.92,percent of total billed charges,80% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% of total billed charges,75.66,37.27,,60.53,percent of total billed charges,37.27% 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,81.2,40,,64.96,percent of total billed charges,40% of total billed charges,75.66,162.4,
IMP SCREW 2.7X10 656,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,348,278.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% 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,139.2,40,,111.36,percent of total billed charges,40% of total billed charges,129.7,278.4,
IMP SCREW 2.7X12,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,348,278.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% 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,139.2,40,,111.36,percent of total billed charges,40% of total billed charges,129.7,278.4,
IMP SCREW 2.7X16,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,348,278.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% 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,139.2,40,,111.36,percent of total billed charges,40% of total billed charges,129.7,278.4,
IMP SCREW 2.7X14 656,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,348,278.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% 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,139.2,40,,111.36,percent of total billed charges,40% of total billed charges,129.7,278.4,
BOVIE BLD ELEC 2.75,5801832,CDM,272,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
BOVIE BLD ELEC 3 COA,5801832,CDM,272,RC,,,Outpatient,,,12,9.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9.6,80,,7.68,percent of total billed charges,80% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% of total billed charges,4.47,37.27,,3.58,percent of total billed charges,37.27% 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,4.8,40,,3.84,percent of total billed charges,40% of total billed charges,4.47,9.6,
BOVIE BLD ELEC 6.5 C,5801832,CDM,272,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
BOVIE BLD ELEC 4 COA,5801832,CDM,272,RC,,,Outpatient,,,14,11.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11.2,80,,8.96,percent of total billed charges,80% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% of total billed charges,5.22,37.27,,4.18,percent of total billed charges,37.27% 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,5.6,40,,4.48,percent of total billed charges,40% of total billed charges,5.22,11.2,
IMP SCR ATHRX 2.7X12,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,201,160.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% 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,80.4,40,,64.32,percent of total billed charges,40% of total billed charges,74.91,160.8,
IMP SCR ARTHX 2.7X16,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,201,160.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% 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,80.4,40,,64.32,percent of total billed charges,40% of total billed charges,74.91,160.8,
IMP SCR ARTHX 2.7X18,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,201,160.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% 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,80.4,40,,64.32,percent of total billed charges,40% of total billed charges,74.91,160.8,
IMP SCR ARTHX 2.7X20,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,201,160.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% 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,80.4,40,,64.32,percent of total billed charges,40% of total billed charges,74.91,160.8,
IMP SCR ARTHX 3.5X12,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,61,48.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% 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,24.4,40,,19.52,percent of total billed charges,40% of total billed charges,22.73,48.8,
IMP SCR ARTHX 3.5X12,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,201,160.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% 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,80.4,40,,64.32,percent of total billed charges,40% of total billed charges,74.91,160.8,
IMP SCR ARTHX 3.5X14,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,201,160.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,160.8,80,,128.64,percent of total billed charges,80% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% of total billed charges,74.91,37.27,,59.93,percent of total billed charges,37.27% 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,80.4,40,,64.32,percent of total billed charges,40% of total billed charges,74.91,160.8,
IMP SCR ARTHX 4.0X60,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,289,231.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,231.2,80,,184.96,percent of total billed charges,80% of total billed charges,107.71,37.27,,86.17,percent of total billed charges,37.27% of total billed charges,107.71,37.27,,86.17,percent of total billed charges,37.27% of total billed charges,107.71,37.27,,86.17,percent of total billed charges,37.27% 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,115.6,40,,92.48,percent of total billed charges,40% of total billed charges,107.71,231.2,
GUIDEWIRE ARTHX 1.35,8605396,CDM,278,RC,C1769,HCPCS,Outpatient,,,58,46.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% 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,23.2,40,,18.56,percent of total billed charges,40% of total billed charges,21.62,46.4,
DRILL BIT ARTHX 2.6,5801832,CDM,272,RC,,,Outpatient,,,306,244.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,244.8,80,,195.84,percent of total billed charges,80% of total billed charges,114.05,37.27,,91.24,percent of total billed charges,37.27% of total billed charges,114.05,37.27,,91.24,percent of total billed charges,37.27% of total billed charges,114.05,37.27,,91.24,percent of total billed charges,37.27% 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,122.4,40,,97.92,percent of total billed charges,40% of total billed charges,114.05,244.8,
DRILL BIT ARTHX 2.0,5801832,CDM,272,RC,,,Outpatient,,,166,132.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132.8,80,,106.24,percent of total billed charges,80% of total billed charges,61.87,37.27,,49.5,percent of total billed charges,37.27% of total billed charges,61.87,37.27,,49.5,percent of total billed charges,37.27% of total billed charges,61.87,37.27,,49.5,percent of total billed charges,37.27% 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,66.4,40,,53.12,percent of total billed charges,40% of total billed charges,61.87,132.8,
IMP DRL SLV ARTHX 2.,5801832,CDM,272,RC,,,Outpatient,,,61,48.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% 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,24.4,40,,19.52,percent of total billed charges,40% of total billed charges,22.73,48.8,
DRILL BIT ARTHX 2.5,5801832,CDM,272,RC,,,Outpatient,,,149,119.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% 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,59.6,40,,47.68,percent of total billed charges,40% of total billed charges,55.53,119.2,
DRILL BIT ARTHX 2.5,5801832,CDM,272,RC,,,Outpatient,,,149,119.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,119.2,80,,95.36,percent of total billed charges,80% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% of total billed charges,55.53,37.27,,44.42,percent of total billed charges,37.27% 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,59.6,40,,47.68,percent of total billed charges,40% of total billed charges,55.53,119.2,
IMP PLT DIS FIB ARTH,8605396,CDM,278,RC,,,Outpatient,,,1270,1016.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1016,80,,812.8,percent of total billed charges,80% of total billed charges,473.33,37.27,,378.66,percent of total billed charges,37.27% of total billed charges,473.33,37.27,,378.66,percent of total billed charges,37.27% of total billed charges,473.33,37.27,,378.66,percent of total billed charges,37.27% 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,508,40,,406.4,percent of total billed charges,40% of total billed charges,473.33,1016,
CORETRAK EX FIX 20MM,5801832,CDM,272,RC,,,Outpatient,,,6815,5452.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5452,80,,4361.6,percent of total billed charges,80% of total billed charges,2539.95,37.27,,2031.96,percent of total billed charges,37.27% of total billed charges,2539.95,37.27,,2031.96,percent of total billed charges,37.27% of total billed charges,2539.95,37.27,,2031.96,percent of total billed charges,37.27% 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,2726,40,,2180.8,percent of total billed charges,40% of total billed charges,2539.95,5452,
IMP SUT ANCHOR CORKS,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,341,272.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% 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,136.4,40,,109.12,percent of total billed charges,40% of total billed charges,127.09,272.8,
NEEDLE LOOP AR-7281,5801832,CDM,272,RC,,,Outpatient,,,33,26.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% 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,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,12.3,26.4,
IMP STR HIP STEM 132,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4331,3464.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3464.8,80,,2771.84,percent of total billed charges,80% of total billed charges,1614.16,37.27,,1291.33,percent of total billed charges,37.27% of total billed charges,1614.16,37.27,,1291.33,percent of total billed charges,37.27% of total billed charges,1614.16,37.27,,1291.33,percent of total billed charges,37.27% 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,1732.4,40,,1385.92,percent of total billed charges,40% of total billed charges,1614.16,3464.8,
IMP UHR BIPO HEAD UH,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,875,700.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,700,80,,560,percent of total billed charges,80% of total billed charges,326.11,37.27,,260.89,percent of total billed charges,37.27% of total billed charges,326.11,37.27,,260.89,percent of total billed charges,37.27% of total billed charges,326.11,37.27,,260.89,percent of total billed charges,37.27% 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,350,40,,280,percent of total billed charges,40% of total billed charges,326.11,700,
DRAIN JP ROUND 10F,5801832,CDM,272,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
DRAIN JP ROUND 15F,5801832,CDM,272,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
DRAIN JP ROUND 19F,5801832,CDM,272,RC,,,Outpatient,,,18,14.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.4,80,,11.52,percent of total billed charges,80% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% of total billed charges,6.71,37.27,,5.37,percent of total billed charges,37.27% 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,7.2,40,,5.76,percent of total billed charges,40% of total billed charges,6.71,14.4,
DRAIN RESERVOIR 100M,5801832,CDM,272,RC,,,Outpatient,,,6,4.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.8,80,,3.84,percent of total billed charges,80% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% of total billed charges,2.24,37.27,,1.79,percent of total billed charges,37.27% 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,2.4,40,,1.92,percent of total billed charges,40% of total billed charges,2.24,4.8,
VISTASEAL APP 35ML V,5801832,CDM,272,RC,,,Outpatient,,,170,136.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136,80,,108.8,percent of total billed charges,80% of total billed charges,63.36,37.27,,50.69,percent of total billed charges,37.27% of total billed charges,63.36,37.27,,50.69,percent of total billed charges,37.27% of total billed charges,63.36,37.27,,50.69,percent of total billed charges,37.27% 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,68,40,,54.4,percent of total billed charges,40% of total billed charges,63.36,136,
IMP HEMOST VIST 10ML,8605396,CDM,278,RC,C1052,HCPCS,Outpatient,,,1392,1113.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1113.6,80,,890.88,percent of total billed charges,80% of total billed charges,518.8,37.27,,415.04,percent of total billed charges,37.27% of total billed charges,518.8,37.27,,415.04,percent of total billed charges,37.27% of total billed charges,518.8,37.27,,415.04,percent of total billed charges,37.27% 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,556.8,40,,445.44,percent of total billed charges,40% of total billed charges,518.8,1113.6,
IMP MEDI PORT POWER,8605396,CDM,278,RC,C1788,HCPCS,Outpatient,,,850,680.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,680,80,,544,percent of total billed charges,80% of total billed charges,316.8,37.27,,253.44,percent of total billed charges,37.27% of total billed charges,316.8,37.27,,253.44,percent of total billed charges,37.27% of total billed charges,316.8,37.27,,253.44,percent of total billed charges,37.27% 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,340,40,,272,percent of total billed charges,40% of total billed charges,316.8,680,
IMP PLUG & PATCH MED,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,600,480.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,480,80,,384,percent of total billed charges,80% of total billed charges,223.62,37.27,,178.9,percent of total billed charges,37.27% of total billed charges,223.62,37.27,,178.9,percent of total billed charges,37.27% of total billed charges,223.62,37.27,,178.9,percent of total billed charges,37.27% 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,240,40,,192,percent of total billed charges,40% of total billed charges,223.62,480,
PURSETRING DEV 65MM,5801832,CDM,272,RC,,,Outpatient,,,395,316.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,316,80,,252.8,percent of total billed charges,80% of total billed charges,147.22,37.27,,117.78,percent of total billed charges,37.27% of total billed charges,147.22,37.27,,117.78,percent of total billed charges,37.27% of total billed charges,147.22,37.27,,117.78,percent of total billed charges,37.27% 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,158,40,,126.4,percent of total billed charges,40% of total billed charges,147.22,316,
GRASPER LAP LOCKING,5801832,CDM,272,RC,,,Outpatient,,,210,168.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168,80,,134.4,percent of total billed charges,80% of total billed charges,78.27,37.27,,62.62,percent of total billed charges,37.27% of total billed charges,78.27,37.27,,62.62,percent of total billed charges,37.27% of total billed charges,78.27,37.27,,62.62,percent of total billed charges,37.27% 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,84,40,,67.2,percent of total billed charges,40% of total billed charges,78.27,168,
KUMAR CHOLANG CATH,5801832,CDM,272,RC,,,Outpatient,,,62,49.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,49.6,80,,39.68,percent of total billed charges,80% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% of total billed charges,23.11,37.27,,18.49,percent of total billed charges,37.27% 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,24.8,40,,19.84,percent of total billed charges,40% of total billed charges,23.11,49.6,
STAPLER CONTOUR CVD,5801832,CDM,272,RC,,,Outpatient,,,455,364.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,364,80,,291.2,percent of total billed charges,80% of total billed charges,169.58,37.27,,135.66,percent of total billed charges,37.27% of total billed charges,169.58,37.27,,135.66,percent of total billed charges,37.27% of total billed charges,169.58,37.27,,135.66,percent of total billed charges,37.27% 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,182,40,,145.6,percent of total billed charges,40% of total billed charges,169.58,364,
STAPLER CONTOUR CVD,5801832,CDM,272,RC,,,Outpatient,,,809,647.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,647.2,80,,517.76,percent of total billed charges,80% of total billed charges,301.51,37.27,,241.21,percent of total billed charges,37.27% of total billed charges,301.51,37.27,,241.21,percent of total billed charges,37.27% of total billed charges,301.51,37.27,,241.21,percent of total billed charges,37.27% 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,323.6,40,,258.88,percent of total billed charges,40% of total billed charges,301.51,647.2,
CLOSURE DEVICE THOMA,5801832,CDM,272,RC,,,Outpatient,,,236,188.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,188.8,80,,151.04,percent of total billed charges,80% of total billed charges,87.96,37.27,,70.37,percent of total billed charges,37.27% of total billed charges,87.96,37.27,,70.37,percent of total billed charges,37.27% of total billed charges,87.96,37.27,,70.37,percent of total billed charges,37.27% 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,94.4,40,,75.52,percent of total billed charges,40% of total billed charges,87.96,188.8,
CLOSURE SUTURE PASSE,5801832,CDM,272,RC,,,Outpatient,,,237,189.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.6,80,,151.68,percent of total billed charges,80% of total billed charges,88.33,37.27,,70.66,percent of total billed charges,37.27% of total billed charges,88.33,37.27,,70.66,percent of total billed charges,37.27% of total billed charges,88.33,37.27,,70.66,percent of total billed charges,37.27% 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,94.8,40,,75.84,percent of total billed charges,40% of total billed charges,88.33,189.6,
CLOSURE DEVICE THOMA,5801832,CDM,272,RC,,,Outpatient,,,308,246.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,246.4,80,,197.12,percent of total billed charges,80% of total billed charges,114.79,37.27,,91.83,percent of total billed charges,37.27% of total billed charges,114.79,37.27,,91.83,percent of total billed charges,37.27% of total billed charges,114.79,37.27,,91.83,percent of total billed charges,37.27% 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,123.2,40,,98.56,percent of total billed charges,40% of total billed charges,114.79,246.4,
SIGMOSCOPE LIGHT KIT,5801832,CDM,272,RC,,,Outpatient,,,269,215.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,215.2,80,,172.16,percent of total billed charges,80% of total billed charges,100.26,37.27,,80.21,percent of total billed charges,37.27% of total billed charges,100.26,37.27,,80.21,percent of total billed charges,37.27% of total billed charges,100.26,37.27,,80.21,percent of total billed charges,37.27% 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,107.6,40,,86.08,percent of total billed charges,40% of total billed charges,100.26,215.2,
LAPAROSCOPIC TIKNOT,5801832,CDM,272,RC,,,Outpatient,,,341,272.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% 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,136.4,40,,109.12,percent of total billed charges,40% of total billed charges,127.09,272.8,
LAPARO TIKNOT LOAD U,5801832,CDM,272,RC,,,Outpatient,,,74,59.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.2,80,,47.36,percent of total billed charges,80% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% of total billed charges,27.58,37.27,,22.06,percent of total billed charges,37.27% 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,29.6,40,,23.68,percent of total billed charges,40% of total billed charges,27.58,59.2,
LIGASURE BLUNT 37CM,5801832,CDM,272,RC,,,Outpatient,,,806,644.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,644.8,80,,515.84,percent of total billed charges,80% of total billed charges,300.4,37.27,,240.32,percent of total billed charges,37.27% of total billed charges,300.4,37.27,,240.32,percent of total billed charges,37.27% of total billed charges,300.4,37.27,,240.32,percent of total billed charges,37.27% 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,322.4,40,,257.92,percent of total billed charges,40% of total billed charges,300.4,644.8,
LIGASURE BLUNT 44CM,5801832,CDM,272,RC,,,Outpatient,,,857,685.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,685.6,80,,548.48,percent of total billed charges,80% of total billed charges,319.4,37.27,,255.52,percent of total billed charges,37.27% of total billed charges,319.4,37.27,,255.52,percent of total billed charges,37.27% of total billed charges,319.4,37.27,,255.52,percent of total billed charges,37.27% 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,342.8,40,,274.24,percent of total billed charges,40% of total billed charges,319.4,685.6,
LIGASURE IMPACT,5801832,CDM,272,RC,,,Outpatient,,,1103,882.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,882.4,80,,705.92,percent of total billed charges,80% of total billed charges,411.09,37.27,,328.87,percent of total billed charges,37.27% of total billed charges,411.09,37.27,,328.87,percent of total billed charges,37.27% of total billed charges,411.09,37.27,,328.87,percent of total billed charges,37.27% 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,441.2,40,,352.96,percent of total billed charges,40% of total billed charges,411.09,882.4,
TROCAR  BLUNT SGL 10,5801832,CDM,272,RC,,,Outpatient,,,298,238.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,238.4,80,,190.72,percent of total billed charges,80% of total billed charges,111.06,37.27,,88.85,percent of total billed charges,37.27% of total billed charges,111.06,37.27,,88.85,percent of total billed charges,37.27% of total billed charges,111.06,37.27,,88.85,percent of total billed charges,37.27% 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,119.2,40,,95.36,percent of total billed charges,40% of total billed charges,111.06,238.4,
STAPLER ENDO GIA 4 U,5801832,CDM,272,RC,,,Outpatient,,,205,164.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164,80,,131.2,percent of total billed charges,80% of total billed charges,76.4,37.27,,61.12,percent of total billed charges,37.27% of total billed charges,76.4,37.27,,61.12,percent of total billed charges,37.27% of total billed charges,76.4,37.27,,61.12,percent of total billed charges,37.27% 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,82,40,,65.6,percent of total billed charges,40% of total billed charges,76.4,164,
SIGNIA POWER CONTROL,5801832,CDM,272,RC,,,Outpatient,,,205,164.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164,80,,131.2,percent of total billed charges,80% of total billed charges,76.4,37.27,,61.12,percent of total billed charges,37.27% of total billed charges,76.4,37.27,,61.12,percent of total billed charges,37.27% of total billed charges,76.4,37.27,,61.12,percent of total billed charges,37.27% 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,82,40,,65.6,percent of total billed charges,40% of total billed charges,76.4,164,
STAPLE ENDO RELOAD 6,5801832,CDM,272,RC,,,Outpatient,,,428,342.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,342.4,80,,273.92,percent of total billed charges,80% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% of total billed charges,159.52,37.27,,127.62,percent of total billed charges,37.27% 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,171.2,40,,136.96,percent of total billed charges,40% of total billed charges,159.52,342.4,
STAPLE ENDO RELOAD 6,5801832,CDM,272,RC,,,Outpatient,,,447,357.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,357.6,80,,286.08,percent of total billed charges,80% of total billed charges,166.6,37.27,,133.28,percent of total billed charges,37.27% of total billed charges,166.6,37.27,,133.28,percent of total billed charges,37.27% of total billed charges,166.6,37.27,,133.28,percent of total billed charges,37.27% 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,178.8,40,,143.04,percent of total billed charges,40% of total billed charges,166.6,357.6,
STAPLE ENDO RELOAD 6,5801832,CDM,272,RC,,,Outpatient,,,447,357.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,357.6,80,,286.08,percent of total billed charges,80% of total billed charges,166.6,37.27,,133.28,percent of total billed charges,37.27% of total billed charges,166.6,37.27,,133.28,percent of total billed charges,37.27% of total billed charges,166.6,37.27,,133.28,percent of total billed charges,37.27% 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,178.8,40,,143.04,percent of total billed charges,40% of total billed charges,166.6,357.6,
STAPLER RELOAD 60 TH,5801832,CDM,272,RC,,,Outpatient,,,563,450.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,450.4,80,,360.32,percent of total billed charges,80% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% 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,225.2,40,,180.16,percent of total billed charges,40% of total billed charges,209.83,450.4,
STAPLER RELOAD 45 TH,5801832,CDM,272,RC,,,Outpatient,,,328,262.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,262.4,80,,209.92,percent of total billed charges,80% of total billed charges,122.25,37.27,,97.8,percent of total billed charges,37.27% of total billed charges,122.25,37.27,,97.8,percent of total billed charges,37.27% of total billed charges,122.25,37.27,,97.8,percent of total billed charges,37.27% 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,131.2,40,,104.96,percent of total billed charges,40% of total billed charges,122.25,262.4,
STAPLER RELOAD 45AMT,5801832,CDM,272,RC,,,Outpatient,,,340,272.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272,80,,217.6,percent of total billed charges,80% of total billed charges,126.72,37.27,,101.38,percent of total billed charges,37.27% of total billed charges,126.72,37.27,,101.38,percent of total billed charges,37.27% of total billed charges,126.72,37.27,,101.38,percent of total billed charges,37.27% 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,136,40,,108.8,percent of total billed charges,40% of total billed charges,126.72,272,
CLIP APPLIER 11.5 ME,5801832,CDM,272,RC,,,Outpatient,,,657,525.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,525.6,80,,420.48,percent of total billed charges,80% of total billed charges,244.86,37.27,,195.89,percent of total billed charges,37.27% of total billed charges,244.86,37.27,,195.89,percent of total billed charges,37.27% of total billed charges,244.86,37.27,,195.89,percent of total billed charges,37.27% 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,262.8,40,,210.24,percent of total billed charges,40% of total billed charges,244.86,525.6,
CLIP APPLIER 13.0 LA,5801832,CDM,272,RC,,,Outpatient,,,95,76.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76,80,,60.8,percent of total billed charges,80% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% of total billed charges,35.41,37.27,,28.33,percent of total billed charges,37.27% 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,38,40,,30.4,percent of total billed charges,40% of total billed charges,35.41,76,
CLIP APPLIER ENDOCLI,5801832,CDM,272,RC,,,Outpatient,,,566,452.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,452.8,80,,362.24,percent of total billed charges,80% of total billed charges,210.95,37.27,,168.76,percent of total billed charges,37.27% of total billed charges,210.95,37.27,,168.76,percent of total billed charges,37.27% of total billed charges,210.95,37.27,,168.76,percent of total billed charges,37.27% 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,226.4,40,,181.12,percent of total billed charges,40% of total billed charges,210.95,452.8,
CLIP APPLIER 10MM,5801832,CDM,272,RC,,,Outpatient,,,118,94.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,94.4,80,,75.52,percent of total billed charges,80% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% of total billed charges,43.98,37.27,,35.18,percent of total billed charges,37.27% 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,47.2,40,,37.76,percent of total billed charges,40% of total billed charges,43.98,94.4,
STAPLER GIA60,5801832,CDM,272,RC,,,Outpatient,,,414,331.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,331.2,80,,264.96,percent of total billed charges,80% of total billed charges,154.3,37.27,,123.44,percent of total billed charges,37.27% of total billed charges,154.3,37.27,,123.44,percent of total billed charges,37.27% of total billed charges,154.3,37.27,,123.44,percent of total billed charges,37.27% 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,165.6,40,,132.48,percent of total billed charges,40% of total billed charges,154.3,331.2,
STAPLER RELOAD BLUE,5801832,CDM,272,RC,,,Outpatient,,,91,72.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% 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,36.4,40,,29.12,percent of total billed charges,40% of total billed charges,33.92,72.8,
STAPLER RELOAD WHITE,5801832,CDM,272,RC,,,Outpatient,,,96,76.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% 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,38.4,40,,30.72,percent of total billed charges,40% of total billed charges,35.78,76.8,
STAPLER EEA 28 THICK,5801832,CDM,272,RC,,,Outpatient,,,650,520.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520,80,,416,percent of total billed charges,80% of total billed charges,242.26,37.27,,193.81,percent of total billed charges,37.27% of total billed charges,242.26,37.27,,193.81,percent of total billed charges,37.27% of total billed charges,242.26,37.27,,193.81,percent of total billed charges,37.27% 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,260,40,,208,percent of total billed charges,40% of total billed charges,242.26,520,
STAPLER EEA 31 THICK,5801832,CDM,272,RC,,,Outpatient,,,650,520.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520,80,,416,percent of total billed charges,80% of total billed charges,242.26,37.27,,193.81,percent of total billed charges,37.27% of total billed charges,242.26,37.27,,193.81,percent of total billed charges,37.27% of total billed charges,242.26,37.27,,193.81,percent of total billed charges,37.27% 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,260,40,,208,percent of total billed charges,40% of total billed charges,242.26,520,
STAPLER EEA25 STANDA,5801832,CDM,272,RC,,,Outpatient,,,577,461.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,461.6,80,,369.28,percent of total billed charges,80% of total billed charges,215.05,37.27,,172.04,percent of total billed charges,37.27% of total billed charges,215.05,37.27,,172.04,percent of total billed charges,37.27% of total billed charges,215.05,37.27,,172.04,percent of total billed charges,37.27% 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,230.8,40,,184.64,percent of total billed charges,40% of total billed charges,215.05,461.6,
MAXCORE BIOPSY GUN 1,5801832,CDM,272,RC,,,Outpatient,,,83,66.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.4,80,,53.12,percent of total billed charges,80% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% of total billed charges,30.93,37.27,,24.74,percent of total billed charges,37.27% 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,33.2,40,,26.56,percent of total billed charges,40% of total billed charges,30.93,66.4,
MAXCORE BIOPSY GUN 1,5801832,CDM,272,RC,,,Outpatient,,,81,64.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,64.8,80,,51.84,percent of total billed charges,80% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% of total billed charges,30.19,37.27,,24.15,percent of total billed charges,37.27% 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,32.4,40,,25.92,percent of total billed charges,40% of total billed charges,30.19,64.8,
BLADE INDIANA TOME,5801832,CDM,272,RC,,,Outpatient,,,543,434.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,434.4,80,,347.52,percent of total billed charges,80% of total billed charges,202.38,37.27,,161.9,percent of total billed charges,37.27% of total billed charges,202.38,37.27,,161.9,percent of total billed charges,37.27% of total billed charges,202.38,37.27,,161.9,percent of total billed charges,37.27% 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,217.2,40,,173.76,percent of total billed charges,40% of total billed charges,202.38,434.4,
CYCLOBENZAPRINE,6400014,CDM,250,RC,,,Outpatient,,,4.25,3.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.4,80,,2.72,percent of total billed charges,80% of total billed charges,1.58,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.58,37.27,,1.26,percent of total billed charges,37.27% of total billed charges,1.58,37.27,,1.26,percent of total billed charges,37.27% 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,1.7,40,,1.36,percent of total billed charges,40% of total billed charges,1.58,3.4,
DRILL BIT 03.133.102,5801832,CDM,272,RC,,,Outpatient,,,432,345.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,345.6,80,,276.48,percent of total billed charges,80% of total billed charges,161.01,37.27,,128.81,percent of total billed charges,37.27% of total billed charges,161.01,37.27,,128.81,percent of total billed charges,37.27% of total billed charges,161.01,37.27,,128.81,percent of total billed charges,37.27% 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,172.8,40,,138.24,percent of total billed charges,40% of total billed charges,161.01,345.6,
DRILL BIT 01.133.109,5801832,CDM,272,RC,,,Outpatient,,,252,201.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,80,,161.28,percent of total billed charges,80% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% 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,100.8,40,,80.64,percent of total billed charges,40% of total billed charges,93.92,201.6,
IMP SCREW 204.820,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,103,82.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% 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,41.2,40,,32.96,percent of total billed charges,40% of total billed charges,38.39,82.4,
IMP PLATE 241.381,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,625,500.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,500,80,,400,percent of total billed charges,80% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% 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,250,40,,200,percent of total billed charges,40% of total billed charges,232.94,500,
IMP SCREW 204.816,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,103,82.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% 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,41.2,40,,32.96,percent of total billed charges,40% of total billed charges,38.39,82.4,
IMP SCREW 204.814,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,103,82.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% 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,41.2,40,,32.96,percent of total billed charges,40% of total billed charges,38.39,82.4,
IMP SCREW 204.812,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,103,82.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% 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,41.2,40,,32.96,percent of total billed charges,40% of total billed charges,38.39,82.4,
IMP SCREW 206.016,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,121,96.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% 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,48.4,40,,38.72,percent of total billed charges,40% of total billed charges,45.1,96.8,
IMP GUIDE 703886,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,884,707.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,707.2,80,,565.76,percent of total billed charges,80% of total billed charges,329.47,37.27,,263.58,percent of total billed charges,37.27% of total billed charges,329.47,37.27,,263.58,percent of total billed charges,37.27% of total billed charges,329.47,37.27,,263.58,percent of total billed charges,37.27% 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,353.6,40,,282.88,percent of total billed charges,40% of total billed charges,329.47,707.2,
IMP OVER DRILL 3.5,8605396,CDM,278,RC,,,Outpatient,,,363,290.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,135.29,37.27,,108.23,percent of total billed charges,37.27% of total billed charges,135.29,37.27,,108.23,percent of total billed charges,37.27% of total billed charges,135.29,37.27,,108.23,percent of total billed charges,37.27% 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,145.2,40,,116.16,percent of total billed charges,40% of total billed charges,135.29,290.4,
IMP SCREW 3.5X12,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,211,168.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,168.8,80,,135.04,percent of total billed charges,80% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% of total billed charges,78.64,37.27,,62.91,percent of total billed charges,37.27% 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,84.4,40,,67.52,percent of total billed charges,40% of total billed charges,78.64,168.8,
IMP SCREW 3.5X20,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,180,144.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,144,80,,115.2,percent of total billed charges,80% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% of total billed charges,67.09,37.27,,53.67,percent of total billed charges,37.27% 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,72,40,,57.6,percent of total billed charges,40% of total billed charges,67.09,144,
K WIRE 702459S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,182,145.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% 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,72.8,40,,58.24,percent of total billed charges,40% of total billed charges,67.83,145.6,
IMP SCREW 4X40,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,348,278.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,278.4,80,,222.72,percent of total billed charges,80% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% of total billed charges,129.7,37.27,,103.76,percent of total billed charges,37.27% 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,139.2,40,,111.36,percent of total billed charges,40% of total billed charges,129.7,278.4,
HEMORRIDE BAND ANOSC,5801832,CDM,272,RC,,,Outpatient,,,9,7.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.2,80,,5.76,percent of total billed charges,80% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% of total billed charges,3.35,37.27,,2.68,percent of total billed charges,37.27% 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,3.6,40,,2.88,percent of total billed charges,40% of total billed charges,3.35,7.2,
ARC ENDOCUFF VISION,5801832,CDM,272,RC,A4270,HCPCS,Outpatient,,,58,46.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,46.4,80,,37.12,percent of total billed charges,80% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% of total billed charges,21.62,37.27,,17.3,percent of total billed charges,37.27% 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,23.2,40,,18.56,percent of total billed charges,40% of total billed charges,21.62,46.4,
DRILL BIT 03.133.102,5801832,CDM,272,RC,,,Outpatient,,,433,346.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,346.4,80,,277.12,percent of total billed charges,80% of total billed charges,161.38,37.27,,129.1,percent of total billed charges,37.27% of total billed charges,161.38,37.27,,129.1,percent of total billed charges,37.27% of total billed charges,161.38,37.27,,129.1,percent of total billed charges,37.27% 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,173.2,40,,138.56,percent of total billed charges,40% of total billed charges,161.38,346.4,
DRILL BIT 03.133.109,5801832,CDM,272,RC,,,Outpatient,,,252,201.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,201.6,80,,161.28,percent of total billed charges,80% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% of total billed charges,93.92,37.27,,75.14,percent of total billed charges,37.27% 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,100.8,40,,80.64,percent of total billed charges,40% of total billed charges,93.92,201.6,
IMP SCREW 204.820,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,103,82.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% 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,41.2,40,,32.96,percent of total billed charges,40% of total billed charges,38.39,82.4,
IMP PLATE 241.381,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,625,500.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,500,80,,400,percent of total billed charges,80% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% 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,250,40,,200,percent of total billed charges,40% of total billed charges,232.94,500,
IMP SCREW 204.816,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,103,82.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% 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,41.2,40,,32.96,percent of total billed charges,40% of total billed charges,38.39,82.4,
IMP SCREW 204.814,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,103,82.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% 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,41.2,40,,32.96,percent of total billed charges,40% of total billed charges,38.39,82.4,
IMP SCREW 204.812,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,103,82.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,82.4,80,,65.92,percent of total billed charges,80% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% of total billed charges,38.39,37.27,,30.71,percent of total billed charges,37.27% 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,41.2,40,,32.96,percent of total billed charges,40% of total billed charges,38.39,82.4,
IMP SCREW 206.016,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,121,96.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% 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,48.4,40,,38.72,percent of total billed charges,40% of total billed charges,45.1,96.8,
GLIDESCOPE GVL 3 STA,5645742,CDM,270,RC,,,Outpatient,,,48,38.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% 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,19.2,40,,15.36,percent of total billed charges,40% of total billed charges,17.89,38.4,
GLIDESCOPE GVL 4 STA,5645742,CDM,270,RC,,,Outpatient,,,48,38.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,38.4,80,,30.72,percent of total billed charges,80% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% of total billed charges,17.89,37.27,,14.31,percent of total billed charges,37.27% 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,19.2,40,,15.36,percent of total billed charges,40% of total billed charges,17.89,38.4,
GLIDESCOPE GVL 2 STA,5645742,CDM,270,RC,,,Outpatient,,,57,45.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,45.6,80,,36.48,percent of total billed charges,80% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% of total billed charges,21.24,37.27,,16.99,percent of total billed charges,37.27% 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,22.8,40,,18.24,percent of total billed charges,40% of total billed charges,21.24,45.6,
GLIDESCOPE STYLET RI,5645742,CDM,270,RC,,,Outpatient,,,91,72.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,72.8,80,,58.24,percent of total billed charges,80% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% of total billed charges,33.92,37.27,,27.14,percent of total billed charges,37.27% 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,36.4,40,,29.12,percent of total billed charges,40% of total billed charges,33.92,72.8,
IMP FIBERSTITCH CVD,8605396,CDM,278,RC,,,Outpatient,,,1239,991.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,991.2,80,,792.96,percent of total billed charges,80% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% 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,495.6,40,,396.48,percent of total billed charges,40% of total billed charges,461.78,991.2,
IMP FIBERSTITCH CVD,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1239,991.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,991.2,80,,792.96,percent of total billed charges,80% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% 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,495.6,40,,396.48,percent of total billed charges,40% of total billed charges,461.78,991.2,
IMP FIBSTCH CVD 24,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1239,991.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,991.2,80,,792.96,percent of total billed charges,80% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% of total billed charges,461.78,37.27,,369.42,percent of total billed charges,37.27% 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,495.6,40,,396.48,percent of total billed charges,40% of total billed charges,461.78,991.2,
SUTURE TENSIONER AR,5801832,CDM,272,RC,,,Outpatient,,,438,350.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,350.4,80,,280.32,percent of total billed charges,80% of total billed charges,163.24,37.27,,130.59,percent of total billed charges,37.27% of total billed charges,163.24,37.27,,130.59,percent of total billed charges,37.27% of total billed charges,163.24,37.27,,130.59,percent of total billed charges,37.27% 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,175.2,40,,140.16,percent of total billed charges,40% of total billed charges,163.24,350.4,
IMDUR 30MG,6400014,CDM,250,RC,,,Outpatient,,,5.6,4.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4.48,80,,3.58,percent of total billed charges,80% of total billed charges,2.09,37.27,,1.67,percent of total billed charges,37.27% of total billed charges,2.09,37.27,,1.67,percent of total billed charges,37.27% of total billed charges,2.09,37.27,,1.67,percent of total billed charges,37.27% 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,2.24,40,,1.79,percent of total billed charges,40% of total billed charges,2.09,4.48,
DAPTOMYCIN,6065130,CDM,636,RC,J0878,HCPCS,Outpatient,,,0.47,0.38,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.38,80,,0.3,percent of total billed charges,80% of total billed charges,0.18,37.27,,0.14,percent of total billed charges,37.27% of total billed charges,0.18,37.27,,0.14,percent of total billed charges,37.27% of total billed charges,0.18,37.27,,0.14,percent of total billed charges,37.27% 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,0.19,40,,0.15,percent of total billed charges,40% of total billed charges,0.18,0.38,
TRI FEM 5517F501,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4200,3360.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3360,80,,2688,percent of total billed charges,80% of total billed charges,1565.34,37.27,,1252.27,percent of total billed charges,37.27% of total billed charges,1565.34,37.27,,1252.27,percent of total billed charges,37.27% of total billed charges,1565.34,37.27,,1252.27,percent of total billed charges,37.27% 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,1680,40,,1344,percent of total billed charges,40% of total billed charges,1565.34,3360,
IMP TRI TIBIAL 55368,8605396,CDM,278,RC,C1777,HCPCS,Outpatient,,,4400,3520.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3520,80,,2816,percent of total billed charges,80% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% 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,1760,40,,1408,percent of total billed charges,40% of total billed charges,1639.88,3520,
IMP TRI TIB BEARING,8605396,CDM,278,RC,C1778,HCPCS,Outpatient,,,1935,1548.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1548,80,,1238.4,percent of total billed charges,80% of total billed charges,721.17,37.27,,576.94,percent of total billed charges,37.27% of total billed charges,721.17,37.27,,576.94,percent of total billed charges,37.27% of total billed charges,721.17,37.27,,576.94,percent of total billed charges,37.27% 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,774,40,,619.2,percent of total billed charges,40% of total billed charges,721.17,1548,
IMP TRI PAT 5552L381,8605396,CDM,278,RC,C1779,HCPCS,Outpatient,,,1375,1100.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1100,80,,880,percent of total billed charges,80% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% 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,550,40,,440,percent of total billed charges,40% of total billed charges,512.46,1100,
SNARE ELECTRO SPIRAL,5801832,CDM,272,RC,,,Outpatient,,,71,56.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56.8,80,,45.44,percent of total billed charges,80% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% of total billed charges,26.46,37.27,,21.17,percent of total billed charges,37.27% 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,28.4,40,,22.72,percent of total billed charges,40% of total billed charges,26.46,56.8,
SNARE COLD BIOPSY,5801832,CDM,272,RC,,,Outpatient,,,41,32.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32.8,80,,26.24,percent of total billed charges,80% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% of total billed charges,15.28,37.27,,12.22,percent of total billed charges,37.27% 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,16.4,40,,13.12,percent of total billed charges,40% of total billed charges,15.28,32.8,
SNARE HOT/COLD BIOPS,5801832,CDM,272,RC,,,Outpatient,,,52,41.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,41.6,80,,33.28,percent of total billed charges,80% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% of total billed charges,19.38,37.27,,15.5,percent of total billed charges,37.27% 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,20.8,40,,16.64,percent of total billed charges,40% of total billed charges,19.38,41.6,
DISTAL ATT CAP GASTR,5801832,CDM,272,RC,,,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% 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,28,40,,22.4,percent of total billed charges,40% of total billed charges,26.09,56,
AMNIOFIX 100MG AL-51,6065130,CDM,636,RC,Q4139,HCPCS,Outpatient,,,4030,3224.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3224,80,,2579.2,percent of total billed charges,80% of total billed charges,1501.98,37.27,,1201.58,percent of total billed charges,37.27% of total billed charges,1501.98,37.27,,1201.58,percent of total billed charges,37.27% of total billed charges,1501.98,37.27,,1201.58,percent of total billed charges,37.27% 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,1612,40,,1289.6,percent of total billed charges,40% of total billed charges,1501.98,3224,
IMP PLATE SH 40-2090,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2157,1725.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1725.6,80,,1380.48,percent of total billed charges,80% of total billed charges,803.91,37.27,,643.13,percent of total billed charges,37.27% of total billed charges,803.91,37.27,,643.13,percent of total billed charges,37.27% of total billed charges,803.91,37.27,,643.13,percent of total billed charges,37.27% 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,862.8,40,,690.24,percent of total billed charges,40% of total billed charges,803.91,1725.6,
IMP SCREW 3.5X18,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% 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,132,40,,105.6,percent of total billed charges,40% of total billed charges,122.99,264,
IMP SCREW 3.5X14,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% 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,132,40,,105.6,percent of total billed charges,40% of total billed charges,122.99,264,
STRYKER NOZ REV FEM,5801832,CDM,272,RC,,,Outpatient,,,312,249.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,249.6,80,,199.68,percent of total billed charges,80% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% of total billed charges,116.28,37.27,,93.02,percent of total billed charges,37.27% 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,124.8,40,,99.84,percent of total billed charges,40% of total billed charges,116.28,249.6,
STRYKER NOZ HUMERAL,5801832,CDM,272,RC,,,Outpatient,,,61,48.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.8,80,,39.04,percent of total billed charges,80% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% of total billed charges,22.73,37.27,,18.18,percent of total billed charges,37.27% 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,24.4,40,,19.52,percent of total billed charges,40% of total billed charges,22.73,48.8,
CEMENT BONE PREP KIT,5801832,CDM,272,RC,,,Outpatient,,,344,275.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,128.21,37.27,,102.57,percent of total billed charges,37.27% of total billed charges,128.21,37.27,,102.57,percent of total billed charges,37.27% of total billed charges,128.21,37.27,,102.57,percent of total billed charges,37.27% 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,137.6,40,,110.08,percent of total billed charges,40% of total billed charges,128.21,275.2,
STRYKER HOOD DISPOSA,5801832,CDM,272,RC,,,Outpatient,,,155,124.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% 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,62,40,,49.6,percent of total billed charges,40% of total billed charges,57.77,124,
STRYKER ZIP SKIN CL,5801832,CDM,272,RC,,,Outpatient,,,374,299.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,299.2,80,,239.36,percent of total billed charges,80% of total billed charges,139.39,37.27,,111.51,percent of total billed charges,37.27% of total billed charges,139.39,37.27,,111.51,percent of total billed charges,37.27% of total billed charges,139.39,37.27,,111.51,percent of total billed charges,37.27% 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,149.6,40,,119.68,percent of total billed charges,40% of total billed charges,139.39,299.2,
STRYK INTERPULSE LAV,5801832,CDM,272,RC,,,Outpatient,,,123,98.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% 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,49.2,40,,39.36,percent of total billed charges,40% of total billed charges,45.84,98.4,
BLADE OFFSET 2296003,5801832,CDM,272,RC,,,Outpatient,,,89,71.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,71.2,80,,56.96,percent of total billed charges,80% of total billed charges,33.17,37.27,,26.54,percent of total billed charges,37.27% of total billed charges,33.17,37.27,,26.54,percent of total billed charges,37.27% of total billed charges,33.17,37.27,,26.54,percent of total billed charges,37.27% 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,35.6,40,,28.48,percent of total billed charges,40% of total billed charges,33.17,71.2,
BLAADE SAG 210838200,5801832,CDM,272,RC,,,Outpatient,,,76,60.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60.8,80,,48.64,percent of total billed charges,80% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% of total billed charges,28.33,37.27,,22.66,percent of total billed charges,37.27% 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,30.4,40,,24.32,percent of total billed charges,40% of total billed charges,28.33,60.8,
BLADE SAG 6113119090,5801832,CDM,272,RC,,,Outpatient,,,152,121.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.6,80,,97.28,percent of total billed charges,80% of total billed charges,56.65,37.27,,45.32,percent of total billed charges,37.27% of total billed charges,56.65,37.27,,45.32,percent of total billed charges,37.27% of total billed charges,56.65,37.27,,45.32,percent of total billed charges,37.27% 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,60.8,40,,48.64,percent of total billed charges,40% of total billed charges,56.65,121.6,
BLADE SAG 6118127090,5801832,CDM,272,RC,,,Outpatient,,,144,115.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% 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,57.6,40,,46.08,percent of total billed charges,40% of total billed charges,53.67,115.2,
BLADE SAG 6125127090,5801832,CDM,272,RC,,,Outpatient,,,144,115.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% 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,57.6,40,,46.08,percent of total billed charges,40% of total billed charges,53.67,115.2,
LAP GLABL DECOM NEDL,5801832,CDM,272,RC,,,Outpatient,,,355,284.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,284,80,,227.2,percent of total billed charges,80% of total billed charges,132.31,37.27,,105.85,percent of total billed charges,37.27% of total billed charges,132.31,37.27,,105.85,percent of total billed charges,37.27% of total billed charges,132.31,37.27,,105.85,percent of total billed charges,37.27% 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,142,40,,113.6,percent of total billed charges,40% of total billed charges,132.31,284,
MESH PARIETEX HERNIA,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,1105,884.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,884,80,,707.2,percent of total billed charges,80% of total billed charges,411.83,37.27,,329.46,percent of total billed charges,37.27% of total billed charges,411.83,37.27,,329.46,percent of total billed charges,37.27% of total billed charges,411.83,37.27,,329.46,percent of total billed charges,37.27% 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,442,40,,353.6,percent of total billed charges,40% of total billed charges,411.83,884,
MESH PARIETEX HERNIA,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,1540,1232.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1232,80,,985.6,percent of total billed charges,80% of total billed charges,573.96,37.27,,459.17,percent of total billed charges,37.27% of total billed charges,573.96,37.27,,459.17,percent of total billed charges,37.27% of total billed charges,573.96,37.27,,459.17,percent of total billed charges,37.27% 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,616,40,,492.8,percent of total billed charges,40% of total billed charges,573.96,1232,
IMP CEMENT BONE GENT,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2032,1625.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1625.6,80,,1300.48,percent of total billed charges,80% of total billed charges,757.33,37.27,,605.86,percent of total billed charges,37.27% of total billed charges,757.33,37.27,,605.86,percent of total billed charges,37.27% of total billed charges,757.33,37.27,,605.86,percent of total billed charges,37.27% 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,812.8,40,,650.24,percent of total billed charges,40% of total billed charges,757.33,1625.6,
IMP TIB INSERT 19613,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,10992,8793.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8793.6,80,,7034.88,percent of total billed charges,80% of total billed charges,4096.72,37.27,,3277.38,percent of total billed charges,37.27% of total billed charges,4096.72,37.27,,3277.38,percent of total billed charges,37.27% of total billed charges,4096.72,37.27,,3277.38,percent of total billed charges,37.27% 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,4396.8,40,,3517.44,percent of total billed charges,40% of total billed charges,4096.72,8793.6,
IMP TIB ROT SZ 3,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,14748,11798.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11798.4,80,,9438.72,percent of total billed charges,80% of total billed charges,5496.58,37.27,,4397.26,percent of total billed charges,37.27% of total billed charges,5496.58,37.27,,4397.26,percent of total billed charges,37.27% of total billed charges,5496.58,37.27,,4397.26,percent of total billed charges,37.27% 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,5899.2,40,,4719.36,percent of total billed charges,40% of total billed charges,5496.58,11798.4,
IMP FEM CRUCIATE SZ3,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,23284,18627.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18627.2,80,,14901.76,percent of total billed charges,80% of total billed charges,8677.95,37.27,,6942.36,percent of total billed charges,37.27% of total billed charges,8677.95,37.27,,6942.36,percent of total billed charges,37.27% of total billed charges,8677.95,37.27,,6942.36,percent of total billed charges,37.27% 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,9313.6,40,,7450.88,percent of total billed charges,40% of total billed charges,8677.95,18627.2,
IMP PAT OVAL DOME,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3880,3104.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3104,80,,2483.2,percent of total billed charges,80% of total billed charges,1446.08,37.27,,1156.86,percent of total billed charges,37.27% of total billed charges,1446.08,37.27,,1156.86,percent of total billed charges,37.27% of total billed charges,1446.08,37.27,,1156.86,percent of total billed charges,37.27% 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,1552,40,,1241.6,percent of total billed charges,40% of total billed charges,1446.08,3104,
K WIRE TROCAR PT 1.6,5801832,CDM,272,RC,C1713,HCPCS,Outpatient,,,490,392.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,392,80,,313.6,percent of total billed charges,80% of total billed charges,182.62,37.27,,146.1,percent of total billed charges,37.27% of total billed charges,182.62,37.27,,146.1,percent of total billed charges,37.27% of total billed charges,182.62,37.27,,146.1,percent of total billed charges,37.27% 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,196,40,,156.8,percent of total billed charges,40% of total billed charges,182.62,392,
PL DSTL RAD 8H 02110,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4776,3820.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3820.8,80,,3056.64,percent of total billed charges,80% of total billed charges,1780.02,37.27,,1424.02,percent of total billed charges,37.27% of total billed charges,1780.02,37.27,,1424.02,percent of total billed charges,37.27% of total billed charges,1780.02,37.27,,1424.02,percent of total billed charges,37.27% 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,1910.4,40,,1528.32,percent of total billed charges,40% of total billed charges,1780.02,3820.8,
DRILL GUIDE 1.8 3230,5801832,CDM,272,RC,,,Outpatient,,,627,501.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,501.6,80,,401.28,percent of total billed charges,80% of total billed charges,233.68,37.27,,186.94,percent of total billed charges,37.27% of total billed charges,233.68,37.27,,186.94,percent of total billed charges,37.27% of total billed charges,233.68,37.27,,186.94,percent of total billed charges,37.27% 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,250.8,40,,200.64,percent of total billed charges,40% of total billed charges,233.68,501.6,
IMP SCR 2.4X14,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,809,647.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,647.2,80,,517.76,percent of total billed charges,80% of total billed charges,301.51,37.27,,241.21,percent of total billed charges,37.27% of total billed charges,301.51,37.27,,241.21,percent of total billed charges,37.27% of total billed charges,301.51,37.27,,241.21,percent of total billed charges,37.27% 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,323.6,40,,258.88,percent of total billed charges,40% of total billed charges,301.51,647.2,
IMP SCR 2.4X18,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,809,647.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,647.2,80,,517.76,percent of total billed charges,80% of total billed charges,301.51,37.27,,241.21,percent of total billed charges,37.27% of total billed charges,301.51,37.27,,241.21,percent of total billed charges,37.27% of total billed charges,301.51,37.27,,241.21,percent of total billed charges,37.27% 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,323.6,40,,258.88,percent of total billed charges,40% of total billed charges,301.51,647.2,
IMP SCR 2.4X15,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,809,647.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,647.2,80,,517.76,percent of total billed charges,80% of total billed charges,301.51,37.27,,241.21,percent of total billed charges,37.27% of total billed charges,301.51,37.27,,241.21,percent of total billed charges,37.27% of total billed charges,301.51,37.27,,241.21,percent of total billed charges,37.27% 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,323.6,40,,258.88,percent of total billed charges,40% of total billed charges,301.51,647.2,
IMP SCR 2.7X14,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,242,193.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,193.6,80,,154.88,percent of total billed charges,80% of total billed charges,90.19,37.27,,72.15,percent of total billed charges,37.27% of total billed charges,90.19,37.27,,72.15,percent of total billed charges,37.27% of total billed charges,90.19,37.27,,72.15,percent of total billed charges,37.27% 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,96.8,40,,77.44,percent of total billed charges,40% of total billed charges,90.19,193.6,
ARTX DISSECTOR 4X13,5645742,CDM,270,RC,,,Outpatient,,,162,129.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% 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,64.8,40,,51.84,percent of total billed charges,40% of total billed charges,60.38,129.6,
ARTX DISSECT 4X13CVD,5645742,CDM,270,RC,,,Outpatient,,,182,145.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,145.6,80,,116.48,percent of total billed charges,80% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% of total billed charges,67.83,37.27,,54.26,percent of total billed charges,37.27% 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,72.8,40,,58.24,percent of total billed charges,40% of total billed charges,67.83,145.6,
ARTX DISSECTOR EXCAL,5645742,CDM,270,RC,,,Outpatient,,,162,129.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% 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,64.8,40,,51.84,percent of total billed charges,40% of total billed charges,60.38,129.6,
ARTX BURR OVAL 5X13,5645742,CDM,270,RC,,,Outpatient,,,162,129.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% 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,64.8,40,,51.84,percent of total billed charges,40% of total billed charges,60.38,129.6,
ARTX WAND ASP ABL 90,5645742,CDM,270,RC,,,Outpatient,,,522,417.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,194.55,37.27,,155.64,percent of total billed charges,37.27% of total billed charges,194.55,37.27,,155.64,percent of total billed charges,37.27% of total billed charges,194.55,37.27,,155.64,percent of total billed charges,37.27% 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,208.8,40,,167.04,percent of total billed charges,40% of total billed charges,194.55,417.6,
ARTX WAND ASP ABL 50,5645742,CDM,270,RC,,,Outpatient,,,547,437.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,203.87,37.27,,163.1,percent of total billed charges,37.27% of total billed charges,203.87,37.27,,163.1,percent of total billed charges,37.27% of total billed charges,203.87,37.27,,163.1,percent of total billed charges,37.27% 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,218.8,40,,175.04,percent of total billed charges,40% of total billed charges,203.87,437.6,
ARTX WAND NON ASP 90,5645742,CDM,270,RC,,,Outpatient,,,509,407.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,407.2,80,,325.76,percent of total billed charges,80% of total billed charges,189.7,37.27,,151.76,percent of total billed charges,37.27% of total billed charges,189.7,37.27,,151.76,percent of total billed charges,37.27% of total billed charges,189.7,37.27,,151.76,percent of total billed charges,37.27% 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,203.6,40,,162.88,percent of total billed charges,40% of total billed charges,189.7,407.2,
ARTX PUMP TUBING,5645742,CDM,270,RC,,,Outpatient,,,168,134.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.4,80,,107.52,percent of total billed charges,80% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% of total billed charges,62.61,37.27,,50.09,percent of total billed charges,37.27% 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,67.2,40,,53.76,percent of total billed charges,40% of total billed charges,62.61,134.4,
IMP TIB INSER 196192,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3712,2969.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2969.6,80,,2375.68,percent of total billed charges,80% of total billed charges,1383.46,37.27,,1106.77,percent of total billed charges,37.27% of total billed charges,1383.46,37.27,,1106.77,percent of total billed charges,37.27% of total billed charges,1383.46,37.27,,1106.77,percent of total billed charges,37.27% 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,1484.8,40,,1187.84,percent of total billed charges,40% of total billed charges,1383.46,2969.6,
IMP TIB ROT SZ4,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4983,3986.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3986.4,80,,3189.12,percent of total billed charges,80% of total billed charges,1857.16,37.27,,1485.73,percent of total billed charges,37.27% of total billed charges,1857.16,37.27,,1485.73,percent of total billed charges,37.27% of total billed charges,1857.16,37.27,,1485.73,percent of total billed charges,37.27% 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,1993.2,40,,1594.56,percent of total billed charges,40% of total billed charges,1857.16,3986.4,
IMP FEM CRUCIATE SZ4,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,7868,6294.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6294.4,80,,5035.52,percent of total billed charges,80% of total billed charges,2932.4,37.27,,2345.92,percent of total billed charges,37.27% of total billed charges,2932.4,37.27,,2345.92,percent of total billed charges,37.27% of total billed charges,2932.4,37.27,,2345.92,percent of total billed charges,37.27% 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,3147.2,40,,2517.76,percent of total billed charges,40% of total billed charges,2932.4,6294.4,
IMP PAT OVAL DOME 35,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,1312,1049.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1049.6,80,,839.68,percent of total billed charges,80% of total billed charges,488.98,37.27,,391.18,percent of total billed charges,37.27% of total billed charges,488.98,37.27,,391.18,percent of total billed charges,37.27% of total billed charges,488.98,37.27,,391.18,percent of total billed charges,37.27% 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,524.8,40,,419.84,percent of total billed charges,40% of total billed charges,488.98,1049.6,
AQUACEL AG SURG 9X25,5645742,CDM,270,RC,,,Outpatient,,,92,73.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,73.6,80,,58.88,percent of total billed charges,80% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% of total billed charges,34.29,37.27,,27.43,percent of total billed charges,37.27% 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,36.8,40,,29.44,percent of total billed charges,40% of total billed charges,34.29,73.6,
IMP SCR AR-1390E,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,316,252.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% 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,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,117.77,252.8,
IMP SCR AR-1391E,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,316,252.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% 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,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,117.77,252.8,
IMP ACL KIT AR-1898S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,399,319.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,319.2,80,,255.36,percent of total billed charges,80% of total billed charges,148.71,37.27,,118.97,percent of total billed charges,37.27% of total billed charges,148.71,37.27,,118.97,percent of total billed charges,37.27% of total billed charges,148.71,37.27,,118.97,percent of total billed charges,37.27% 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,159.6,40,,127.68,percent of total billed charges,40% of total billed charges,148.71,319.2,
IMP SCRW 2.7X14 AR88,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,316,252.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% 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,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,117.77,252.8,
IMP SCRW 4X40 AR8840,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,316,252.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% 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,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,117.77,252.8,
IMP TROPE AR8925SS,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4111,3288.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3288.8,80,,2631.04,percent of total billed charges,80% of total billed charges,1532.17,37.27,,1225.74,percent of total billed charges,37.27% of total billed charges,1532.17,37.27,,1225.74,percent of total billed charges,37.27% of total billed charges,1532.17,37.27,,1225.74,percent of total billed charges,37.27% 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,1644.4,40,,1315.52,percent of total billed charges,40% of total billed charges,1532.17,3288.8,
IMP PL 5H AR8943,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1788,1430.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1430.4,80,,1144.32,percent of total billed charges,80% of total billed charges,666.39,37.27,,533.11,percent of total billed charges,37.27% of total billed charges,666.39,37.27,,533.11,percent of total billed charges,37.27% of total billed charges,666.39,37.27,,533.11,percent of total billed charges,37.27% 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,715.2,40,,572.16,percent of total billed charges,40% of total billed charges,666.39,1430.4,
DRILL BIT 2.5 AR894L,5801832,CDM,272,RC,,,Outpatient,,,234,187.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.2,80,,149.76,percent of total billed charges,80% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% 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,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,87.21,187.2,
MAGNESIUM SO4 2GM PM,6065130,CDM,636,RC,J3475,HCPCS,Outpatient,,,53.65,42.92,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,42.92,80,,34.34,percent of total billed charges,80% of total billed charges,20,37.27,,16,percent of total billed charges,37.27% of total billed charges,20,37.27,,16,percent of total billed charges,37.27% of total billed charges,20,37.27,,16,percent of total billed charges,37.27% 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,21.46,40,,17.17,percent of total billed charges,40% of total billed charges,20,42.92,
PEG TUB CHG NO GUIDE,8602000,CDM,750,RC,SURG,HCPCS,Outpatient,,,2100,1680.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1680,80,,1344,percent of total billed charges,80% of total billed charges,782.67,37.27,,626.14,percent of total billed charges,37.27% of total billed charges,782.67,37.27,,626.14,percent of total billed charges,37.27% of total billed charges,782.67,37.27,,626.14,percent of total billed charges,37.27% 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,840,40,,672,percent of total billed charges,40% of total billed charges,782.67,1680,
IMP TRI FEM 5517F601,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,6600,5280.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5280,80,,4224,percent of total billed charges,80% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% 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,2640,40,,2112,percent of total billed charges,40% of total billed charges,2459.82,5280,
IMP TRI TIB BEAR 553,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,3025,2420.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
TRI PATELLA 5552L350,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,1375,1100.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1100,80,,880,percent of total billed charges,80% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% 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,550,40,,440,percent of total billed charges,40% of total billed charges,512.46,1100,
DRILL BIT AO 1.7MM A,5801832,CDM,272,RC,,,Outpatient,,,280,224.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,224,80,,179.2,percent of total billed charges,80% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% of total billed charges,104.36,37.27,,83.49,percent of total billed charges,37.27% 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,112,40,,89.6,percent of total billed charges,40% of total billed charges,104.36,224,
IMP SCREW 2.4X14 AR1,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,193,154.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.4,80,,123.52,percent of total billed charges,80% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% 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,77.2,40,,61.76,percent of total billed charges,40% of total billed charges,71.93,154.4,
IMP SCREW 2.4X15 AR1,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,193,154.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.4,80,,123.52,percent of total billed charges,80% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% 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,77.2,40,,61.76,percent of total billed charges,40% of total billed charges,71.93,154.4,
IMP SCREW 2.4X16,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,193,154.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.4,80,,123.52,percent of total billed charges,80% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% 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,77.2,40,,61.76,percent of total billed charges,40% of total billed charges,71.93,154.4,
IMP PLATE 2.4 8H,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2186,1748.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1748.8,80,,1399.04,percent of total billed charges,80% of total billed charges,814.72,37.27,,651.78,percent of total billed charges,37.27% of total billed charges,814.72,37.27,,651.78,percent of total billed charges,37.27% of total billed charges,814.72,37.27,,651.78,percent of total billed charges,37.27% 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,874.4,40,,699.52,percent of total billed charges,40% of total billed charges,814.72,1748.8,
IMP SCREW 2.4X14,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,415,332.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332,80,,265.6,percent of total billed charges,80% of total billed charges,154.67,37.27,,123.74,percent of total billed charges,37.27% of total billed charges,154.67,37.27,,123.74,percent of total billed charges,37.27% of total billed charges,154.67,37.27,,123.74,percent of total billed charges,37.27% 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,166,40,,132.8,percent of total billed charges,40% of total billed charges,154.67,332,
IMP SCREW 2X18,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,415,332.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332,80,,265.6,percent of total billed charges,80% of total billed charges,154.67,37.27,,123.74,percent of total billed charges,37.27% of total billed charges,154.67,37.27,,123.74,percent of total billed charges,37.27% of total billed charges,154.67,37.27,,123.74,percent of total billed charges,37.27% 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,166,40,,132.8,percent of total billed charges,40% of total billed charges,154.67,332,
ELEVIEW 10 ML,6400014,CDM,250,RC,,,Outpatient,,,143,114.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,114.4,80,,91.52,percent of total billed charges,80% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% of total billed charges,53.3,37.27,,42.64,percent of total billed charges,37.27% 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,57.2,40,,45.76,percent of total billed charges,40% of total billed charges,53.3,114.4,
IMP SCREW 2.4X20,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,415,332.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,332,80,,265.6,percent of total billed charges,80% of total billed charges,154.67,37.27,,123.74,percent of total billed charges,37.27% of total billed charges,154.67,37.27,,123.74,percent of total billed charges,37.27% of total billed charges,154.67,37.27,,123.74,percent of total billed charges,37.27% 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,166,40,,132.8,percent of total billed charges,40% of total billed charges,154.67,332,
K WIRE 390157,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,33,26.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.4,80,,21.12,percent of total billed charges,80% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% of total billed charges,12.3,37.27,,9.84,percent of total billed charges,37.27% 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,13.2,40,,10.56,percent of total billed charges,40% of total billed charges,12.3,26.4,
IMP ELBOW 629363,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3170,2536.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2536,80,,2028.8,percent of total billed charges,80% of total billed charges,1181.46,37.27,,945.17,percent of total billed charges,37.27% of total billed charges,1181.46,37.27,,945.17,percent of total billed charges,37.27% of total billed charges,1181.46,37.27,,945.17,percent of total billed charges,37.27% 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,1268,40,,1014.4,percent of total billed charges,40% of total billed charges,1181.46,2536,
IMP SCREW 3.5X24 657,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,331,264.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264.8,80,,211.84,percent of total billed charges,80% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% 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,132.4,40,,105.92,percent of total billed charges,40% of total billed charges,123.36,264.8,
IMP SCREW 3.5X18 657,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,609,487.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,487.2,80,,389.76,percent of total billed charges,80% of total billed charges,226.97,37.27,,181.58,percent of total billed charges,37.27% of total billed charges,226.97,37.27,,181.58,percent of total billed charges,37.27% of total billed charges,226.97,37.27,,181.58,percent of total billed charges,37.27% 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,243.6,40,,194.88,percent of total billed charges,40% of total billed charges,226.97,487.2,
IMP SCREW 3.5X22 657,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,609,487.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,487.2,80,,389.76,percent of total billed charges,80% of total billed charges,226.97,37.27,,181.58,percent of total billed charges,37.27% of total billed charges,226.97,37.27,,181.58,percent of total billed charges,37.27% of total billed charges,226.97,37.27,,181.58,percent of total billed charges,37.27% 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,243.6,40,,194.88,percent of total billed charges,40% of total billed charges,226.97,487.2,
IMP FEMORA  5510F302,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4950,3960.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3960,80,,3168,percent of total billed charges,80% of total billed charges,1844.87,37.27,,1475.9,percent of total billed charges,37.27% of total billed charges,1844.87,37.27,,1475.9,percent of total billed charges,37.27% of total billed charges,1844.87,37.27,,1475.9,percent of total billed charges,37.27% 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,1980,40,,1584,percent of total billed charges,40% of total billed charges,1844.87,3960,
IMP TIB BASE PLATE,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2965,2372.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2372,80,,1897.6,percent of total billed charges,80% of total billed charges,1105.06,37.27,,884.05,percent of total billed charges,37.27% of total billed charges,1105.06,37.27,,884.05,percent of total billed charges,37.27% of total billed charges,1105.06,37.27,,884.05,percent of total billed charges,37.27% 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,1186,40,,948.8,percent of total billed charges,40% of total billed charges,1105.06,2372,
IMP PATELLA PLT 5551,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1348,1078.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1078.4,80,,862.72,percent of total billed charges,80% of total billed charges,502.4,37.27,,401.92,percent of total billed charges,37.27% of total billed charges,502.4,37.27,,401.92,percent of total billed charges,37.27% of total billed charges,502.4,37.27,,401.92,percent of total billed charges,37.27% 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,539.2,40,,431.36,percent of total billed charges,40% of total billed charges,502.4,1078.4,
BONE CEMENT 61921001,5801832,CDM,272,RC,,,Outpatient,,,609,487.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,487.2,80,,389.76,percent of total billed charges,80% of total billed charges,226.97,37.27,,181.58,percent of total billed charges,37.27% of total billed charges,226.97,37.27,,181.58,percent of total billed charges,37.27% of total billed charges,226.97,37.27,,181.58,percent of total billed charges,37.27% 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,243.6,40,,194.88,percent of total billed charges,40% of total billed charges,226.97,487.2,
TROPE TAG AR1588RTT,8605396,CDM,278,RC,,,Outpatient,,,1444,1155.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1155.2,80,,924.16,percent of total billed charges,80% of total billed charges,538.18,37.27,,430.54,percent of total billed charges,37.27% of total billed charges,538.18,37.27,,430.54,percent of total billed charges,37.27% of total billed charges,538.18,37.27,,430.54,percent of total billed charges,37.27% 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,577.6,40,,462.08,percent of total billed charges,40% of total billed charges,538.18,1155.2,
TROPE PIN AR1595TC,8605396,CDM,278,RC,,,Outpatient,,,344,275.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,128.21,37.27,,102.57,percent of total billed charges,37.27% of total billed charges,128.21,37.27,,102.57,percent of total billed charges,37.27% of total billed charges,128.21,37.27,,102.57,percent of total billed charges,37.27% 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,137.6,40,,110.08,percent of total billed charges,40% of total billed charges,128.21,275.2,
STRIPPER AR238509,8605396,CDM,278,RC,,,Outpatient,,,481,384.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384.8,80,,307.84,percent of total billed charges,80% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% 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,192.4,40,,153.92,percent of total billed charges,40% of total billed charges,179.27,384.8,
HARVESTER AR238609,8605396,CDM,278,RC,,,Outpatient,,,1169,935.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.2,80,,748.16,percent of total billed charges,80% of total billed charges,435.69,37.27,,348.55,percent of total billed charges,37.27% of total billed charges,435.69,37.27,,348.55,percent of total billed charges,37.27% of total billed charges,435.69,37.27,,348.55,percent of total billed charges,37.27% 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,467.6,40,,374.08,percent of total billed charges,40% of total billed charges,435.69,935.2,
IMP SCREW 9X20 AR402,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,811,648.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,648.8,80,,519.04,percent of total billed charges,80% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% 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,324.4,40,,259.52,percent of total billed charges,40% of total billed charges,302.26,648.8,
SUTURETAPE AR7534,5801832,CDM,272,RC,,,Outpatient,,,193,154.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.4,80,,123.52,percent of total billed charges,80% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% of total billed charges,71.93,37.27,,57.54,percent of total billed charges,37.27% 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,77.2,40,,61.76,percent of total billed charges,40% of total billed charges,71.93,154.4,
IMP SCREW AR1380E,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,316,252.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% 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,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,117.77,252.8,
IMP SCREW AR1390,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,261,208.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,208.8,80,,167.04,percent of total billed charges,80% of total billed charges,97.27,37.27,,77.82,percent of total billed charges,37.27% of total billed charges,97.27,37.27,,77.82,percent of total billed charges,37.27% of total billed charges,97.27,37.27,,77.82,percent of total billed charges,37.27% 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,104.4,40,,83.52,percent of total billed charges,40% of total billed charges,97.27,208.8,
ACL KIT DISP AR1898S,5801832,CDM,272,RC,,,Outpatient,,,399,319.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,319.2,80,,255.36,percent of total billed charges,80% of total billed charges,148.71,37.27,,118.97,percent of total billed charges,37.27% of total billed charges,148.71,37.27,,118.97,percent of total billed charges,37.27% of total billed charges,148.71,37.27,,118.97,percent of total billed charges,37.27% 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,159.6,40,,127.68,percent of total billed charges,40% of total billed charges,148.71,319.2,
SUTURE PASS AB13995B,5801832,CDM,272,RC,,,Outpatient,,,468,374.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,374.4,80,,299.52,percent of total billed charges,80% of total billed charges,174.42,37.27,,139.54,percent of total billed charges,37.27% of total billed charges,174.42,37.27,,139.54,percent of total billed charges,37.27% of total billed charges,174.42,37.27,,139.54,percent of total billed charges,37.27% 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,187.2,40,,149.76,percent of total billed charges,40% of total billed charges,174.42,374.4,
POSITIONER AR162706,5801832,CDM,272,RC,,,Outpatient,,,55,44.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,44,80,,35.2,percent of total billed charges,80% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% of total billed charges,20.5,37.27,,16.4,percent of total billed charges,37.27% 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,22,40,,17.6,percent of total billed charges,40% of total billed charges,20.5,44,
IMP ANCHOR AR1927BCF,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,935,748.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,748,80,,598.4,percent of total billed charges,80% of total billed charges,348.47,37.27,,278.78,percent of total billed charges,37.27% of total billed charges,348.47,37.27,,278.78,percent of total billed charges,37.27% of total billed charges,348.47,37.27,,278.78,percent of total billed charges,37.27% 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,374,40,,299.2,percent of total billed charges,40% of total billed charges,348.47,748,
CANNULA AR6530TD,5801832,CDM,272,RC,,,Outpatient,,,88,70.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,70.4,80,,56.32,percent of total billed charges,80% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% of total billed charges,32.8,37.27,,26.24,percent of total billed charges,37.27% 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,35.2,40,,28.16,percent of total billed charges,40% of total billed charges,32.8,70.4,
PFIZER COVID-19 VAC,6065130,CDM,636,RC,91300,HCPCS,Outpatient,,,12.7,10.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
SUT ANCHOR AR1923PS,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,906,724.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,724.8,80,,579.84,percent of total billed charges,80% of total billed charges,337.67,37.27,,270.14,percent of total billed charges,37.27% of total billed charges,337.67,37.27,,270.14,percent of total billed charges,37.27% of total billed charges,337.67,37.27,,270.14,percent of total billed charges,37.27% 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,362.4,40,,289.92,percent of total billed charges,40% of total billed charges,337.67,724.8,
SUT LASSO AR4068545L,5645742,CDM,270,RC,,,Outpatient,,,550,440.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,440,80,,352,percent of total billed charges,80% of total billed charges,204.99,37.27,,163.99,percent of total billed charges,37.27% of total billed charges,204.99,37.27,,163.99,percent of total billed charges,37.27% of total billed charges,204.99,37.27,,163.99,percent of total billed charges,37.27% 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,220,40,,176,percent of total billed charges,40% of total billed charges,204.99,440,
CANNULA THRED AR6567,5645742,CDM,270,RC,,,Outpatient,,,99,79.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,80,,63.36,percent of total billed charges,80% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% of total billed charges,36.9,37.27,,29.52,percent of total billed charges,37.27% 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,39.6,40,,31.68,percent of total billed charges,40% of total billed charges,36.9,79.2,
FIBERWIRE #2 AR73209,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,197,157.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% 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,78.8,40,,63.04,percent of total billed charges,40% of total billed charges,73.42,157.6,
HARVESTER AR238610,5801832,CDM,272,RC,,,Outpatient,,,1672,1337.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1337.6,80,,1070.08,percent of total billed charges,80% of total billed charges,623.15,37.27,,498.52,percent of total billed charges,37.27% of total billed charges,623.15,37.27,,498.52,percent of total billed charges,37.27% of total billed charges,623.15,37.27,,498.52,percent of total billed charges,37.27% 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,668.8,40,,535.04,percent of total billed charges,40% of total billed charges,623.15,1337.6,
SCR 10X20 AR4020C10,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1161,928.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,928.8,80,,743.04,percent of total billed charges,80% of total billed charges,432.7,37.27,,346.16,percent of total billed charges,37.27% of total billed charges,432.7,37.27,,346.16,percent of total billed charges,37.27% of total billed charges,432.7,37.27,,346.16,percent of total billed charges,37.27% 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,464.4,40,,371.52,percent of total billed charges,40% of total billed charges,432.7,928.8,
SWIVELOCK AR2324BCC,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1573,1258.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1258.4,80,,1006.72,percent of total billed charges,80% of total billed charges,586.26,37.27,,469.01,percent of total billed charges,37.27% of total billed charges,586.26,37.27,,469.01,percent of total billed charges,37.27% of total billed charges,586.26,37.27,,469.01,percent of total billed charges,37.27% 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,629.2,40,,503.36,percent of total billed charges,40% of total billed charges,586.26,1258.4,
TROPE TAG AR1588RTJ,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1018,814.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,814.4,80,,651.52,percent of total billed charges,80% of total billed charges,379.41,37.27,,303.53,percent of total billed charges,37.27% of total billed charges,379.41,37.27,,303.53,percent of total billed charges,37.27% of total billed charges,379.41,37.27,,303.53,percent of total billed charges,37.27% 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,407.2,40,,325.76,percent of total billed charges,40% of total billed charges,379.41,814.4,
SUTURETAPE AR7535T,5645742,CDM,270,RC,,,Outpatient,,,234,187.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.2,80,,149.76,percent of total billed charges,80% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% 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,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,87.21,187.2,
DRILL BIT 317861,5801832,CDM,272,RC,,,Outpatient,,,426,340.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,340.8,80,,272.64,percent of total billed charges,80% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% 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,170.4,40,,136.32,percent of total billed charges,40% of total billed charges,158.77,340.8,
IMP SCR CORTX 201612,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,292,233.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,108.83,37.27,,87.06,percent of total billed charges,37.27% of total billed charges,108.83,37.27,,87.06,percent of total billed charges,37.27% of total billed charges,108.83,37.27,,87.06,percent of total billed charges,37.27% 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,116.8,40,,93.44,percent of total billed charges,40% of total billed charges,108.83,233.6,
IMP SCR CORTX 201614,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,292,233.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,108.83,37.27,,87.06,percent of total billed charges,37.27% of total billed charges,108.83,37.27,,87.06,percent of total billed charges,37.27% of total billed charges,108.83,37.27,,87.06,percent of total billed charges,37.27% 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,116.8,40,,93.44,percent of total billed charges,40% of total billed charges,108.83,233.6,
IMP SCR CORTX 201616,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,292,233.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,233.6,80,,186.88,percent of total billed charges,80% of total billed charges,108.83,37.27,,87.06,percent of total billed charges,37.27% of total billed charges,108.83,37.27,,87.06,percent of total billed charges,37.27% of total billed charges,108.83,37.27,,87.06,percent of total billed charges,37.27% 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,116.8,40,,93.44,percent of total billed charges,40% of total billed charges,108.83,233.6,
GRAFT 1.8 SGD1800,6065130,CDM,636,RC,Q4101,HCPCS,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% 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,198,40,,158.4,percent of total billed charges,40% of total billed charges,184.49,396,
GRAFT 2X2 SGD202,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,781,624.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,624.8,80,,499.84,percent of total billed charges,80% of total billed charges,291.08,37.27,,232.86,percent of total billed charges,37.27% of total billed charges,291.08,37.27,,232.86,percent of total billed charges,37.27% of total billed charges,291.08,37.27,,232.86,percent of total billed charges,37.27% 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,312.4,40,,249.92,percent of total billed charges,40% of total billed charges,291.08,624.8,
FIBERWIRE 2 AR7200,5801832,CDM,272,RC,,,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% 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,198,40,,158.4,percent of total billed charges,40% of total billed charges,184.49,396,
FIBERWIRE 5 AR7210,5801832,CDM,272,RC,,,Outpatient,,,781,624.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,624.8,80,,499.84,percent of total billed charges,80% of total billed charges,291.08,37.27,,232.86,percent of total billed charges,37.27% of total billed charges,291.08,37.27,,232.86,percent of total billed charges,37.27% of total billed charges,291.08,37.27,,232.86,percent of total billed charges,37.27% 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,312.4,40,,249.92,percent of total billed charges,40% of total billed charges,291.08,624.8,
FIBERWIRE 2.0 AR7220,5801832,CDM,272,RC,,,Outpatient,,,660,528.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,528,80,,422.4,percent of total billed charges,80% of total billed charges,245.98,37.27,,196.78,percent of total billed charges,37.27% of total billed charges,245.98,37.27,,196.78,percent of total billed charges,37.27% of total billed charges,245.98,37.27,,196.78,percent of total billed charges,37.27% 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,264,40,,211.2,percent of total billed charges,40% of total billed charges,245.98,528,
KNEE KIT BONE 414502,8605396,CDM,278,RC,,,Outpatient,,,12622,10097.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10097.6,80,,8078.08,percent of total billed charges,80% of total billed charges,4704.22,37.27,,3763.38,percent of total billed charges,37.27% of total billed charges,4704.22,37.27,,3763.38,percent of total billed charges,37.27% of total billed charges,4704.22,37.27,,3763.38,percent of total billed charges,37.27% 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,5048.8,40,,4039.04,percent of total billed charges,40% of total billed charges,4704.22,10097.6,
SCREW 3.5X28 204828,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,176,140.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% 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,70.4,40,,56.32,percent of total billed charges,40% of total billed charges,65.6,140.8,
SCREW 3.5X20 204820,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,176,140.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% 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,70.4,40,,56.32,percent of total billed charges,40% of total billed charges,65.6,140.8,
PLATE LCP 241371,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,918,734.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,734.4,80,,587.52,percent of total billed charges,80% of total billed charges,342.14,37.27,,273.71,percent of total billed charges,37.27% of total billed charges,342.14,37.27,,273.71,percent of total billed charges,37.27% of total billed charges,342.14,37.27,,273.71,percent of total billed charges,37.27% 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,367.2,40,,293.76,percent of total billed charges,40% of total billed charges,342.14,734.4,
SCREW 3.5X14 212103,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,723,578.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,578.4,80,,462.72,percent of total billed charges,80% of total billed charges,269.46,37.27,,215.57,percent of total billed charges,37.27% of total billed charges,269.46,37.27,,215.57,percent of total billed charges,37.27% of total billed charges,269.46,37.27,,215.57,percent of total billed charges,37.27% 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,289.2,40,,231.36,percent of total billed charges,40% of total billed charges,269.46,578.4,
TIBIAL TRI 5536B600,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4400,3520.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3520,80,,2816,percent of total billed charges,80% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% 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,1760,40,,1408,percent of total billed charges,40% of total billed charges,1639.88,3520,
TIB BEAR 5530F610,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
PUSHLOCK  AR1923DS,5801832,CDM,272,RC,,,Outpatient,,,481,384.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384.8,80,,307.84,percent of total billed charges,80% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% 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,192.4,40,,153.92,percent of total billed charges,40% of total billed charges,179.27,384.8,
SUT LASSO AR406845R,5801832,CDM,272,RC,,,Outpatient,,,385,308.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308,80,,246.4,percent of total billed charges,80% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% 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,154,40,,123.2,percent of total billed charges,40% of total billed charges,143.49,308,
SUT TAK 3 AR1934BCT2,5801832,CDM,272,RC,,,Outpatient,,,990,792.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,792,80,,633.6,percent of total billed charges,80% of total billed charges,368.97,37.27,,295.18,percent of total billed charges,37.27% of total billed charges,368.97,37.27,,295.18,percent of total billed charges,37.27% of total billed charges,368.97,37.27,,295.18,percent of total billed charges,37.27% 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,396,40,,316.8,percent of total billed charges,40% of total billed charges,368.97,792,
ARTHREX RF90 AR9811,5801832,CDM,272,RC,,,Outpatient,,,522,417.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,417.6,80,,334.08,percent of total billed charges,80% of total billed charges,194.55,37.27,,155.64,percent of total billed charges,37.27% of total billed charges,194.55,37.27,,155.64,percent of total billed charges,37.27% of total billed charges,194.55,37.27,,155.64,percent of total billed charges,37.27% 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,208.8,40,,167.04,percent of total billed charges,40% of total billed charges,194.55,417.6,
ARTHREX RF50 AR9815,5801832,CDM,272,RC,,,Outpatient,,,547,437.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,203.87,37.27,,163.1,percent of total billed charges,37.27% of total billed charges,203.87,37.27,,163.1,percent of total billed charges,37.27% of total billed charges,203.87,37.27,,163.1,percent of total billed charges,37.27% 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,218.8,40,,175.04,percent of total billed charges,40% of total billed charges,203.87,437.6,
GRAFT EVO AT801FF,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,6187,4949.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4949.6,80,,3959.68,percent of total billed charges,80% of total billed charges,2305.89,37.27,,1844.71,percent of total billed charges,37.27% of total billed charges,2305.89,37.27,,1844.71,percent of total billed charges,37.27% of total billed charges,2305.89,37.27,,1844.71,percent of total billed charges,37.27% 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,2474.8,40,,1979.84,percent of total billed charges,40% of total billed charges,2305.89,4949.6,
ACL GR KNIFE 232110,5801832,CDM,272,RC,,,Outpatient,,,679,543.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,543.2,80,,434.56,percent of total billed charges,80% of total billed charges,253.06,37.27,,202.45,percent of total billed charges,37.27% of total billed charges,253.06,37.27,,202.45,percent of total billed charges,37.27% of total billed charges,253.06,37.27,,202.45,percent of total billed charges,37.27% 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,271.6,40,,217.28,percent of total billed charges,40% of total billed charges,253.06,543.2,
ACUFEX TOOL 014723,5801832,CDM,272,RC,,,Outpatient,,,996,796.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,796.8,80,,637.44,percent of total billed charges,80% of total billed charges,371.21,37.27,,296.97,percent of total billed charges,37.27% of total billed charges,371.21,37.27,,296.97,percent of total billed charges,37.27% of total billed charges,371.21,37.27,,296.97,percent of total billed charges,37.27% 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,398.4,40,,318.72,percent of total billed charges,40% of total billed charges,371.21,796.8,
CANULA SHOULDER 9718,5801832,CDM,272,RC,,,Outpatient,,,45,36.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,36,80,,28.8,percent of total billed charges,80% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% of total billed charges,16.77,37.27,,13.42,percent of total billed charges,37.27% 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,18,40,,14.4,percent of total billed charges,40% of total billed charges,16.77,36,
SCR BIOCOMP AR1400C,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,646,516.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% 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,258.4,40,,206.72,percent of total billed charges,40% of total billed charges,240.76,516.8,
SURGIFLO THROMBIN,5801832,CDM,272,RC,,,Outpatient,,,750,600.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600,80,,480,percent of total billed charges,80% of total billed charges,279.53,37.27,,223.62,percent of total billed charges,37.27% of total billed charges,279.53,37.27,,223.62,percent of total billed charges,37.27% of total billed charges,279.53,37.27,,223.62,percent of total billed charges,37.27% 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,300,40,,240,percent of total billed charges,40% of total billed charges,279.53,600,
TRI FEM 5517F202,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,6600,5280.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5280,80,,4224,percent of total billed charges,80% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% 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,2640,40,,2112,percent of total billed charges,40% of total billed charges,2459.82,5280,
TRI TIB 5536B200,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4400,3520.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3520,80,,2816,percent of total billed charges,80% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% 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,1760,40,,1408,percent of total billed charges,40% of total billed charges,1639.88,3520,
TIB BEAR 5530G209E,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
TRI PAT 5552L320,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,1375,1100.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1100,80,,880,percent of total billed charges,80% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% 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,550,40,,440,percent of total billed charges,40% of total billed charges,512.46,1100,
ARTHREX DISSECTR 5X1,5801832,CDM,272,RC,,,Outpatient,,,162,129.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% 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,64.8,40,,51.84,percent of total billed charges,40% of total billed charges,60.38,129.6,
ARTHREX BURR ROUND 4,5801832,CDM,272,RC,,,Outpatient,,,162,129.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.6,80,,103.68,percent of total billed charges,80% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% of total billed charges,60.38,37.27,,48.3,percent of total billed charges,37.27% 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,64.8,40,,51.84,percent of total billed charges,40% of total billed charges,60.38,129.6,
"SUT FIBERLOOP 20"" #2",5801832,CDM,272,RC,,,Outpatient,,,137,109.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,109.6,80,,87.68,percent of total billed charges,80% of total billed charges,51.06,37.27,,40.85,percent of total billed charges,37.27% of total billed charges,51.06,37.27,,40.85,percent of total billed charges,37.27% of total billed charges,51.06,37.27,,40.85,percent of total billed charges,37.27% 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,54.8,40,,43.84,percent of total billed charges,40% of total billed charges,51.06,109.6,
K WIRE 705002,5801832,CDM,272,RC,,,Outpatient,,,189,151.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,151.2,80,,120.96,percent of total billed charges,80% of total billed charges,70.44,37.27,,56.35,percent of total billed charges,37.27% of total billed charges,70.44,37.27,,56.35,percent of total billed charges,37.27% of total billed charges,70.44,37.27,,56.35,percent of total billed charges,37.27% 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,75.6,40,,60.48,percent of total billed charges,40% of total billed charges,70.44,151.2,
DRI BIT 705031,5801832,CDM,272,RC,,,Outpatient,,,915,732.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,732,80,,585.6,percent of total billed charges,80% of total billed charges,341.02,37.27,,272.82,percent of total billed charges,37.27% of total billed charges,341.02,37.27,,272.82,percent of total billed charges,37.27% of total billed charges,341.02,37.27,,272.82,percent of total billed charges,37.27% 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,366,40,,292.8,percent of total billed charges,40% of total billed charges,341.02,732,
DRI BIT 705025,5801832,CDM,272,RC,,,Outpatient,,,929,743.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,743.2,80,,594.56,percent of total billed charges,80% of total billed charges,346.24,37.27,,276.99,percent of total billed charges,37.27% of total billed charges,346.24,37.27,,276.99,percent of total billed charges,37.27% of total billed charges,346.24,37.27,,276.99,percent of total billed charges,37.27% 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,371.6,40,,297.28,percent of total billed charges,40% of total billed charges,346.24,743.2,
FIXATOR PIN 705019,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,802,641.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,641.6,80,,513.28,percent of total billed charges,80% of total billed charges,298.91,37.27,,239.13,percent of total billed charges,37.27% of total billed charges,298.91,37.27,,239.13,percent of total billed charges,37.27% of total billed charges,298.91,37.27,,239.13,percent of total billed charges,37.27% 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,320.8,40,,256.64,percent of total billed charges,40% of total billed charges,298.91,641.6,
PL 9H FIB 4020909,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2431,1944.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1944.8,80,,1555.84,percent of total billed charges,80% of total billed charges,906.03,37.27,,724.82,percent of total billed charges,37.27% of total billed charges,906.03,37.27,,724.82,percent of total billed charges,37.27% of total billed charges,906.03,37.27,,724.82,percent of total billed charges,37.27% 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,972.4,40,,777.92,percent of total billed charges,40% of total billed charges,906.03,1944.8,
PL 6H TIBIA 627436,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5350,4280.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4280,80,,3424,percent of total billed charges,80% of total billed charges,1993.95,37.27,,1595.16,percent of total billed charges,37.27% of total billed charges,1993.95,37.27,,1595.16,percent of total billed charges,37.27% of total billed charges,1993.95,37.27,,1595.16,percent of total billed charges,37.27% 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,2140,40,,1712,percent of total billed charges,40% of total billed charges,1993.95,4280,
SCR 3.5X15 657416,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,330,264.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264,80,,211.2,percent of total billed charges,80% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% of total billed charges,122.99,37.27,,98.39,percent of total billed charges,37.27% 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,132,40,,105.6,percent of total billed charges,40% of total billed charges,122.99,264,
SCR 3.5X21 661432,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% 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,44,40,,35.2,percent of total billed charges,40% of total billed charges,41,88,
SCR 3.5X40 661440SCR,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,110,88.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% 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,44,40,,35.2,percent of total billed charges,40% of total billed charges,41,88,
SCR 3.5X34 661434,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% 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,44,40,,35.2,percent of total billed charges,40% of total billed charges,41,88,
SCR 3.5X22 661422,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% 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,44,40,,35.2,percent of total billed charges,40% of total billed charges,41,88,
SCR 3.5X26 661426,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% 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,44,40,,35.2,percent of total billed charges,40% of total billed charges,41,88,
SCR 3.5X80 661480,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% 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,44,40,,35.2,percent of total billed charges,40% of total billed charges,41,88,
SCR 4.0X30 661030,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,532,425.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% 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,212.8,40,,170.24,percent of total billed charges,40% of total billed charges,198.28,425.6,
SCR 4.0X38 661038,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,532,425.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% 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,212.8,40,,170.24,percent of total billed charges,40% of total billed charges,198.28,425.6,
SCR 4.0X38 661038,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,532,425.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% 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,212.8,40,,170.24,percent of total billed charges,40% of total billed charges,198.28,425.6,
SCR 4.0X40 661040,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,532,425.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% 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,212.8,40,,170.24,percent of total billed charges,40% of total billed charges,198.28,425.6,
SCR 4.0X18 661018,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,532,425.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,425.6,80,,340.48,percent of total billed charges,80% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% of total billed charges,198.28,37.27,,158.62,percent of total billed charges,37.27% 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,212.8,40,,170.24,percent of total billed charges,40% of total billed charges,198.28,425.6,
HYDRALAZINE 100MG,6400014,CDM,250,RC,,,Outpatient,,,1.85,1.48,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1.48,80,,1.18,percent of total billed charges,80% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% of total billed charges,0.69,37.27,,0.55,percent of total billed charges,37.27% 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,0.74,40,,0.59,percent of total billed charges,40% of total billed charges,0.69,1.48,
CASIRIVIMAB 300MG,6065130,CDM,636,RC,,,Outpatient,,,0.05,0.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,80,,0.03,percent of total billed charges,80% of total billed charges,0.02,37.27,,0.02,percent of total billed charges,37.27% of total billed charges,0.02,37.27,,0.02,percent of total billed charges,37.27% of total billed charges,0.02,37.27,,0.02,percent of total billed charges,37.27% 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,0.02,40,,0.02,percent of total billed charges,40% of total billed charges,0.02,0.04,
IMDEVIMAB 300MG,6065130,CDM,636,RC,,,Outpatient,,,0.05,0.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.04,80,,0.03,percent of total billed charges,80% of total billed charges,0.02,37.27,,0.02,percent of total billed charges,37.27% of total billed charges,0.02,37.27,,0.02,percent of total billed charges,37.27% of total billed charges,0.02,37.27,,0.02,percent of total billed charges,37.27% 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,0.02,40,,0.02,percent of total billed charges,40% of total billed charges,0.02,0.04,
IVERMECTIN 3MG,6400014,CDM,250,RC,,,Outpatient,,,16.9,13.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.52,80,,10.82,percent of total billed charges,80% of total billed charges,6.3,37.27,,5.04,percent of total billed charges,37.27% of total billed charges,6.3,37.27,,5.04,percent of total billed charges,37.27% of total billed charges,6.3,37.27,,5.04,percent of total billed charges,37.27% 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,6.76,40,,5.41,percent of total billed charges,40% of total billed charges,6.3,13.52,
PERC INSERT AR1923PK,5645742,CDM,270,RC,,,Outpatient,,,605,484.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,484,80,,387.2,percent of total billed charges,80% of total billed charges,225.48,37.27,,180.38,percent of total billed charges,37.27% of total billed charges,225.48,37.27,,180.38,percent of total billed charges,37.27% of total billed charges,225.48,37.27,,180.38,percent of total billed charges,37.27% 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,242,40,,193.6,percent of total billed charges,40% of total billed charges,225.48,484,
STAR SLV TRA AR1606V,5645742,CDM,270,RC,,,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
SUTTAPE NDL AR7523,5645742,CDM,270,RC,,,Outpatient,,,316,252.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% 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,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,117.77,252.8,
ZONE NAV HDL AR7900,5801832,CDM,272,RC,,,Outpatient,,,688,550.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,550.4,80,,440.32,percent of total billed charges,80% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% 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,275.2,40,,220.16,percent of total billed charges,40% of total billed charges,256.42,550.4,
ZONE NAV CAN AR7905,5801832,CDM,272,RC,,,Outpatient,,,413,330.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% 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,165.2,40,,132.16,percent of total billed charges,40% of total billed charges,153.93,330.4,
ZONE NAV CAN AR7910R,5801832,CDM,272,RC,,,Outpatient,,,413,330.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% 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,165.2,40,,132.16,percent of total billed charges,40% of total billed charges,153.93,330.4,
ADHERUS ET,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2338,1870.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1870.4,80,,1496.32,percent of total billed charges,80% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% 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,935.2,40,,748.16,percent of total billed charges,40% of total billed charges,871.37,1870.4,
TRI FEM 5517F202,8605396,CDM,278,RC,C1777,HCPCS,Outpatient,,,6600,5280.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5280,80,,4224,percent of total billed charges,80% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% 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,2640,40,,2112,percent of total billed charges,40% of total billed charges,2459.82,5280,
TRI TIB 5536B200,8605396,CDM,278,RC,C1777,HCPCS,Outpatient,,,4400,3520.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3520,80,,2816,percent of total billed charges,80% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% 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,1760,40,,1408,percent of total billed charges,40% of total billed charges,1639.88,3520,
TIB BEAR 5530G209E,8605396,CDM,278,RC,C1777,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
TRI PAT 5552L320,8605396,CDM,278,RC,C1777,HCPCS,Outpatient,,,1375,1100.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1100,80,,880,percent of total billed charges,80% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% 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,550,40,,440,percent of total billed charges,40% of total billed charges,512.46,1100,
SURGIFLO THROMBIN,5801832,CDM,272,RC,,,Outpatient,,,745,596.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,596,80,,476.8,percent of total billed charges,80% of total billed charges,277.66,37.27,,222.13,percent of total billed charges,37.27% of total billed charges,277.66,37.27,,222.13,percent of total billed charges,37.27% of total billed charges,277.66,37.27,,222.13,percent of total billed charges,37.27% 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,298,40,,238.4,percent of total billed charges,40% of total billed charges,277.66,596,
SCR BIOCOMP AR1400C,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,646,516.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% 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,258.4,40,,206.72,percent of total billed charges,40% of total billed charges,240.76,516.8,
PAT DOME 960102,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3880,3104.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3104,80,,2483.2,percent of total billed charges,80% of total billed charges,1446.08,37.27,,1156.86,percent of total billed charges,37.27% of total billed charges,1446.08,37.27,,1156.86,percent of total billed charges,37.27% of total billed charges,1446.08,37.27,,1156.86,percent of total billed charges,37.27% 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,1552,40,,1241.6,percent of total billed charges,40% of total billed charges,1446.08,3104,
TIB INSERT 196192052,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,10992,8793.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8793.6,80,,7034.88,percent of total billed charges,80% of total billed charges,4096.72,37.27,,3277.38,percent of total billed charges,37.27% of total billed charges,4096.72,37.27,,3277.38,percent of total billed charges,37.27% of total billed charges,4096.72,37.27,,3277.38,percent of total billed charges,37.27% 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,4396.8,40,,3517.44,percent of total billed charges,40% of total billed charges,4096.72,8793.6,
TIB TRAY 129433150,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,14748,11798.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11798.4,80,,9438.72,percent of total billed charges,80% of total billed charges,5496.58,37.27,,4397.26,percent of total billed charges,37.27% of total billed charges,5496.58,37.27,,4397.26,percent of total billed charges,37.27% of total billed charges,5496.58,37.27,,4397.26,percent of total billed charges,37.27% 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,5899.2,40,,4719.36,percent of total billed charges,40% of total billed charges,5496.58,11798.4,
FEM CRUCIATE 940015,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,23284,18627.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,18627.2,80,,14901.76,percent of total billed charges,80% of total billed charges,8677.95,37.27,,6942.36,percent of total billed charges,37.27% of total billed charges,8677.95,37.27,,6942.36,percent of total billed charges,37.27% of total billed charges,8677.95,37.27,,6942.36,percent of total billed charges,37.27% 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,9313.6,40,,7450.88,percent of total billed charges,40% of total billed charges,8677.95,18627.2,
FEM CRUCIATE 940029,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,7868,6294.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6294.4,80,,5035.52,percent of total billed charges,80% of total billed charges,2932.4,37.27,,2345.92,percent of total billed charges,37.27% of total billed charges,2932.4,37.27,,2345.92,percent of total billed charges,37.27% of total billed charges,2932.4,37.27,,2345.92,percent of total billed charges,37.27% 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,3147.2,40,,2517.76,percent of total billed charges,40% of total billed charges,2932.4,6294.4,
SURGIGRAFT PER SQ CM,8605396,CDM,278,RC,Q4183,HCPCS,Outpatient,,,781,624.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,624.8,80,,499.84,percent of total billed charges,80% of total billed charges,291.08,37.27,,232.86,percent of total billed charges,37.27% of total billed charges,291.08,37.27,,232.86,percent of total billed charges,37.27% of total billed charges,291.08,37.27,,232.86,percent of total billed charges,37.27% 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,312.4,40,,249.92,percent of total billed charges,40% of total billed charges,291.08,624.8,
US GUIDE NDL ASP BX,6000566,CDM,402,RC,10005,HCPCS,Outpatient,,,1710,1368.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1368,80,,1094.4,percent of total billed charges,80% of total billed charges,637.32,37.27,,509.86,percent of total billed charges,37.27% of total billed charges,637.32,37.27,,509.86,percent of total billed charges,37.27% of total billed charges,637.32,37.27,,509.86,percent of total billed charges,37.27% of total billed charges,580.1,100,,,fee schedule,100% of APC rate,580.1,100,,,fee schedule,100% of APC rate,580.1,100,,,fee schedule,100% of APC rate,102.12,145,,,fee schedule,145% of CMS fee schedule,580.1,100,,,fee schedule,100% of APC rate,580.1,100,,,fee schedule,100% of APC rate,580.1,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,684,40,,547.2,percent of total billed charges,40% of total billed charges,102.12,1368,
US GU NDL ASP BX ADD,6000566,CDM,402,RC,10006,HCPCS,Outpatient,,,750,600.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600,80,,480,percent of total billed charges,80% of total billed charges,279.53,37.27,,223.62,percent of total billed charges,37.27% of total billed charges,279.53,37.27,,223.62,percent of total billed charges,37.27% of total billed charges,279.53,37.27,,223.62,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,69.85,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,40,,240,percent of total billed charges,40% of total billed charges,69.85,600,
US GUIDED THYROID BX,6000566,CDM,402,RC,60100,HCPCS,Outpatient,,,1710,1368.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1368,80,,1094.4,percent of total billed charges,80% of total billed charges,637.32,37.27,,509.86,percent of total billed charges,37.27% of total billed charges,637.32,37.27,,509.86,percent of total billed charges,37.27% of total billed charges,637.32,37.27,,509.86,percent of total billed charges,37.27% of total billed charges,580.1,100,,,fee schedule,100% of APC rate,580.1,100,,,fee schedule,100% of APC rate,580.1,100,,,fee schedule,100% of APC rate,107.08,145,,,fee schedule,145% of CMS fee schedule,580.1,100,,,fee schedule,100% of APC rate,580.1,100,,,fee schedule,100% of APC rate,580.1,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,684,40,,547.2,percent of total billed charges,40% of total billed charges,107.08,1368,
US GUIDE BREAST BX 1,6000566,CDM,402,RC,19083,HCPCS,Outpatient,,,3869,3095.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3095.2,80,,2476.16,percent of total billed charges,80% of total billed charges,1441.98,37.27,,1153.58,percent of total billed charges,37.27% of total billed charges,1441.98,37.27,,1153.58,percent of total billed charges,37.27% of total billed charges,1441.98,37.27,,1153.58,percent of total billed charges,37.27% of total billed charges,1336.76,100,,,fee schedule,100% of APC rate,1336.76,100,,,fee schedule,100% of APC rate,1336.76,100,,,fee schedule,100% of APC rate,214.35,145,,,fee schedule,145% of CMS fee schedule,1336.76,100,,,fee schedule,100% of APC rate,1336.76,100,,,fee schedule,100% of APC rate,1336.76,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1547.6,40,,1238.08,percent of total billed charges,40% of total billed charges,214.35,3095.2,
US GUIDE BRST BX ADD,6000566,CDM,402,RC,19084,HCPCS,Outpatient,,,1935,1548.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1548,80,,1238.4,percent of total billed charges,80% of total billed charges,721.17,37.27,,576.94,percent of total billed charges,37.27% of total billed charges,721.17,37.27,,576.94,percent of total billed charges,37.27% of total billed charges,721.17,37.27,,576.94,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,106.89,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,774,40,,619.2,percent of total billed charges,40% of total billed charges,106.89,1548,
STRIPPER AR238510,5645742,CDM,270,RC,,,Outpatient,,,481,384.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384.8,80,,307.84,percent of total billed charges,80% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% 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,192.4,40,,153.92,percent of total billed charges,40% of total billed charges,179.27,384.8,
SCR BIOCOM AR5028C09,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,646,516.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% 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,258.4,40,,206.72,percent of total billed charges,40% of total billed charges,240.76,516.8,
HIP STEM 605106525,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,6808,5446.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5446.4,80,,4357.12,percent of total billed charges,80% of total billed charges,2537.34,37.27,,2029.87,percent of total billed charges,37.27% of total billed charges,2537.34,37.27,,2029.87,percent of total billed charges,37.27% of total billed charges,2537.34,37.27,,2029.87,percent of total billed charges,37.27% 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,2723.2,40,,2178.56,percent of total billed charges,40% of total billed charges,2537.34,5446.4,
BIPOLAR HEAD UH14628,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,1375,1100.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1100,80,,880,percent of total billed charges,80% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% 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,550,40,,440,percent of total billed charges,40% of total billed charges,512.46,1100,
HIP STEM 60980630,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4125,3300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3300,80,,2640,percent of total billed charges,80% of total billed charges,1537.39,37.27,,1229.91,percent of total billed charges,37.27% of total billed charges,1537.39,37.27,,1229.91,percent of total billed charges,37.27% of total billed charges,1537.39,37.27,,1229.91,percent of total billed charges,37.27% 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,1650,40,,1320,percent of total billed charges,40% of total billed charges,1537.39,3300,
BIPOLAR HEAD US14326,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,1375,1100.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1100,80,,880,percent of total billed charges,80% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% 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,550,40,,440,percent of total billed charges,40% of total billed charges,512.46,1100,
FEM HEAD 062605,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,1238,990.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,990.4,80,,792.32,percent of total billed charges,80% of total billed charges,461.4,37.27,,369.12,percent of total billed charges,37.27% of total billed charges,461.4,37.27,,369.12,percent of total billed charges,37.27% of total billed charges,461.4,37.27,,369.12,percent of total billed charges,37.27% 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,495.2,40,,396.16,percent of total billed charges,40% of total billed charges,461.4,990.4,
SPACER 10670011,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
PUTTY 5CC 81120005S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2750,2200.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2200,80,,1760,percent of total billed charges,80% of total billed charges,1024.93,37.27,,819.94,percent of total billed charges,37.27% of total billed charges,1024.93,37.27,,819.94,percent of total billed charges,37.27% of total billed charges,1024.93,37.27,,819.94,percent of total billed charges,37.27% 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,1100,40,,880,percent of total billed charges,40% of total billed charges,1024.93,2200,
SCREW 4.2X14 161014,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,619,495.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,495.2,80,,396.16,percent of total billed charges,80% of total billed charges,230.7,37.27,,184.56,percent of total billed charges,37.27% of total billed charges,230.7,37.27,,184.56,percent of total billed charges,37.27% of total billed charges,230.7,37.27,,184.56,percent of total billed charges,37.27% 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,247.6,40,,198.08,percent of total billed charges,40% of total billed charges,230.7,495.2,
SPACER 6MM 365406CS,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4125,3300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3300,80,,2640,percent of total billed charges,80% of total billed charges,1537.39,37.27,,1229.91,percent of total billed charges,37.27% of total billed charges,1537.39,37.27,,1229.91,percent of total billed charges,37.27% of total billed charges,1537.39,37.27,,1229.91,percent of total billed charges,37.27% 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,1650,40,,1320,percent of total billed charges,40% of total billed charges,1537.39,3300,
PLATE 3L 161345,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5255,4204.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4204,80,,3363.2,percent of total billed charges,80% of total billed charges,1958.54,37.27,,1566.83,percent of total billed charges,37.27% of total billed charges,1958.54,37.27,,1566.83,percent of total billed charges,37.27% of total billed charges,1958.54,37.27,,1566.83,percent of total billed charges,37.27% 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,2102,40,,1681.6,percent of total billed charges,40% of total billed charges,1958.54,4204,
TIB TRAY 129433130,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4983,3986.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3986.4,80,,3189.12,percent of total billed charges,80% of total billed charges,1857.16,37.27,,1485.73,percent of total billed charges,37.27% of total billed charges,1857.16,37.27,,1485.73,percent of total billed charges,37.27% of total billed charges,1857.16,37.27,,1485.73,percent of total billed charges,37.27% 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,1993.2,40,,1594.56,percent of total billed charges,40% of total billed charges,1857.16,3986.4,
TIB INSERT 196192043,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3738,2990.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2990.4,80,,2392.32,percent of total billed charges,80% of total billed charges,1393.15,37.27,,1114.52,percent of total billed charges,37.27% of total billed charges,1393.15,37.27,,1114.52,percent of total billed charges,37.27% of total billed charges,1393.15,37.27,,1114.52,percent of total billed charges,37.27% 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,1495.2,40,,1196.16,percent of total billed charges,40% of total billed charges,1393.15,2990.4,
HEALIX ANC 222298,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1686,1348.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1348.8,80,,1079.04,percent of total billed charges,80% of total billed charges,628.37,37.27,,502.7,percent of total billed charges,37.27% of total billed charges,628.37,37.27,,502.7,percent of total billed charges,37.27% of total billed charges,628.37,37.27,,502.7,percent of total billed charges,37.27% 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,674.4,40,,539.52,percent of total billed charges,40% of total billed charges,628.37,1348.8,
SCR 4X46 604646S,8605396,CDM,278,RC,,,Outpatient,,,546,436.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,436.8,80,,349.44,percent of total billed charges,80% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% 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,218.4,40,,174.72,percent of total billed charges,40% of total billed charges,203.49,436.8,
OR LVL 1 FIRST 30,8612012,CDM,360,RC,SURG,HCPCS,Outpatient,,,4326,3460.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3460.8,80,,2768.64,percent of total billed charges,80% of total billed charges,1612.3,37.27,,1289.84,percent of total billed charges,37.27% of total billed charges,1612.3,37.27,,1289.84,percent of total billed charges,37.27% of total billed charges,1612.3,37.27,,1289.84,percent of total billed charges,37.27% 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,1730.4,40,,1384.32,percent of total billed charges,40% of total billed charges,1612.3,3460.8,
OR LVL 2 FIRST 30,8612012,CDM,360,RC,SURG,HCPCS,Outpatient,,,4644,3715.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3715.2,80,,2972.16,percent of total billed charges,80% of total billed charges,1730.82,37.27,,1384.66,percent of total billed charges,37.27% of total billed charges,1730.82,37.27,,1384.66,percent of total billed charges,37.27% of total billed charges,1730.82,37.27,,1384.66,percent of total billed charges,37.27% 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,1857.6,40,,1486.08,percent of total billed charges,40% of total billed charges,1730.82,3715.2,
OR LVL 3 FIRST 30 M,8612012,CDM,360,RC,SURG,HCPCS,Outpatient,,,6028,4822.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4822.4,80,,3857.92,percent of total billed charges,80% of total billed charges,2246.64,37.27,,1797.31,percent of total billed charges,37.27% of total billed charges,2246.64,37.27,,1797.31,percent of total billed charges,37.27% of total billed charges,2246.64,37.27,,1797.31,percent of total billed charges,37.27% 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,2411.2,40,,1928.96,percent of total billed charges,40% of total billed charges,2246.64,4822.4,
OR LVL 1 EA ADDL 30M,8612012,CDM,360,RC,SURG,HCPCS,Outpatient,,,144,115.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% 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,57.6,40,,46.08,percent of total billed charges,40% of total billed charges,53.67,115.2,
OR LVL 2 EA ADDL 30M,8612012,CDM,360,RC,SURG,HCPCS,Outpatient,,,155,124.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124,80,,99.2,percent of total billed charges,80% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% of total billed charges,57.77,37.27,,46.22,percent of total billed charges,37.27% 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,62,40,,49.6,percent of total billed charges,40% of total billed charges,57.77,124,
OR LVL 3 EA ADDL 30,8612012,CDM,360,RC,SURG,HCPCS,Outpatient,,,208,166.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,166.4,80,,133.12,percent of total billed charges,80% of total billed charges,77.52,37.27,,62.02,percent of total billed charges,37.27% of total billed charges,77.52,37.27,,62.02,percent of total billed charges,37.27% of total billed charges,77.52,37.27,,62.02,percent of total billed charges,37.27% 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,83.2,40,,66.56,percent of total billed charges,40% of total billed charges,77.52,166.4,
OR LVL 4 EA ADDL 30,8612012,CDM,360,RC,SURG,HCPCS,Outpatient,,,205,164.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164,80,,131.2,percent of total billed charges,80% of total billed charges,76.4,37.27,,61.12,percent of total billed charges,37.27% of total billed charges,76.4,37.27,,61.12,percent of total billed charges,37.27% of total billed charges,76.4,37.27,,61.12,percent of total billed charges,37.27% 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,82,40,,65.6,percent of total billed charges,40% of total billed charges,76.4,164,
OR LLV 4 FIRST 30 M,8612012,CDM,360,RC,SURG,HCPCS,Outpatient,,,6227,4981.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4981.6,80,,3985.28,percent of total billed charges,80% of total billed charges,2320.8,37.27,,1856.64,percent of total billed charges,37.27% of total billed charges,2320.8,37.27,,1856.64,percent of total billed charges,37.27% of total billed charges,2320.8,37.27,,1856.64,percent of total billed charges,37.27% 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,2490.8,40,,1992.64,percent of total billed charges,40% of total billed charges,2320.8,4981.6,
RECOVERY FIRST 30 MI,8602010,CDM,710,RC,,,Outpatient,,,900,720.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,720,80,,576,percent of total billed charges,80% of total billed charges,335.43,37.27,,268.34,percent of total billed charges,37.27% of total billed charges,335.43,37.27,,268.34,percent of total billed charges,37.27% of total billed charges,335.43,37.27,,268.34,percent of total billed charges,37.27% 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,360,40,,288,percent of total billed charges,40% of total billed charges,335.43,720,
RECOVERY EA ADD MIN,8602010,CDM,710,RC,,,Outpatient,,,30,24.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,24,80,,19.2,percent of total billed charges,80% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% of total billed charges,11.18,37.27,,8.94,percent of total billed charges,37.27% 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,12,40,,9.6,percent of total billed charges,40% of total billed charges,11.18,24,
DBM PUTTY 10CC,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3561,2848.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2848.8,80,,2279.04,percent of total billed charges,80% of total billed charges,1327.18,37.27,,1061.74,percent of total billed charges,37.27% of total billed charges,1327.18,37.27,,1061.74,percent of total billed charges,37.27% of total billed charges,1327.18,37.27,,1061.74,percent of total billed charges,37.27% 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,1424.4,40,,1139.52,percent of total billed charges,40% of total billed charges,1327.18,2848.8,
PLATE 1L 12MM 161112,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2338,1870.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1870.4,80,,1496.32,percent of total billed charges,80% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% 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,935.2,40,,748.16,percent of total billed charges,40% of total billed charges,871.37,1870.4,
GEL BIO 2CC 81150202,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,1375,1100.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1100,80,,880,percent of total billed charges,80% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% 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,550,40,,440,percent of total billed charges,40% of total billed charges,512.46,1100,
PIN DISC 12MM 665612,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,275,220.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
SPA 12X14 7MM 365407,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2338,1870.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1870.4,80,,1496.32,percent of total billed charges,80% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% 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,935.2,40,,748.16,percent of total billed charges,40% of total billed charges,871.37,1870.4,
LIPID 20% 250ML,6400499,CDM,259,RC,,,Outpatient,,,104.25,83.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,83.4,80,,66.72,percent of total billed charges,80% of total billed charges,38.85,37.27,,31.08,percent of total billed charges,37.27% of total billed charges,38.85,37.27,,31.08,percent of total billed charges,37.27% of total billed charges,38.85,37.27,,31.08,percent of total billed charges,37.27% 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,41.7,40,,33.36,percent of total billed charges,40% of total billed charges,38.85,83.4,
BB TAK AR13226,5645742,CDM,270,RC,,,Outpatient,,,138,110.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.4,80,,88.32,percent of total billed charges,80% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% 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,55.2,40,,44.16,percent of total billed charges,40% of total billed charges,51.43,110.4,
SCR 2.4X20 AR8724V20,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,385,308.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308,80,,246.4,percent of total billed charges,80% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% 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,154,40,,123.2,percent of total billed charges,40% of total billed charges,143.49,308,
SCR 2.4X24 AR8724V24,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,385,308.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308,80,,246.4,percent of total billed charges,80% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% 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,154,40,,123.2,percent of total billed charges,40% of total billed charges,143.49,308,
SCR 2.4X26 AR8724V26,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,385,308.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308,80,,246.4,percent of total billed charges,80% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% 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,154,40,,123.2,percent of total billed charges,40% of total billed charges,143.49,308,
SCR 3.5X16 AR873516,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,165,132.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% 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,66,40,,52.8,percent of total billed charges,40% of total billed charges,61.5,132,
SCR 3.5X18 AR873518,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,165,132.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% 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,66,40,,52.8,percent of total billed charges,40% of total billed charges,61.5,132,
SCR 3.5X16 AR8735L16,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,234,187.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.2,80,,149.76,percent of total billed charges,80% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% of total billed charges,87.21,37.27,,69.77,percent of total billed charges,37.27% 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,93.6,40,,74.88,percent of total billed charges,40% of total billed charges,87.21,187.2,
DRILL BIT AR891606,5645742,CDM,270,RC,,,Outpatient,,,187,149.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.6,80,,119.68,percent of total billed charges,80% of total billed charges,69.69,37.27,,55.75,percent of total billed charges,37.27% of total billed charges,69.69,37.27,,55.75,percent of total billed charges,37.27% of total billed charges,69.69,37.27,,55.75,percent of total billed charges,37.27% 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,74.8,40,,59.84,percent of total billed charges,40% of total billed charges,69.69,149.6,
DRILL BIT AR891614,5645742,CDM,270,RC,,,Outpatient,,,217,173.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,173.6,80,,138.88,percent of total billed charges,80% of total billed charges,80.88,37.27,,64.7,percent of total billed charges,37.27% of total billed charges,80.88,37.27,,64.7,percent of total billed charges,37.27% of total billed charges,80.88,37.27,,64.7,percent of total billed charges,37.27% 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,86.8,40,,69.44,percent of total billed charges,40% of total billed charges,80.88,173.6,
DRILL SLV AR891618,5645742,CDM,270,RC,,,Outpatient,,,124,99.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,99.2,80,,79.36,percent of total billed charges,80% of total billed charges,46.21,37.27,,36.97,percent of total billed charges,37.27% of total billed charges,46.21,37.27,,36.97,percent of total billed charges,37.27% of total billed charges,46.21,37.27,,36.97,percent of total billed charges,37.27% 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,49.6,40,,39.68,percent of total billed charges,40% of total billed charges,46.21,99.2,
PLATE 5H AR8916VSL05,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2186,1748.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1748.8,80,,1399.04,percent of total billed charges,80% of total billed charges,814.72,37.27,,651.78,percent of total billed charges,37.27% of total billed charges,814.72,37.27,,651.78,percent of total billed charges,37.27% of total billed charges,814.72,37.27,,651.78,percent of total billed charges,37.27% 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,874.4,40,,699.52,percent of total billed charges,40% of total billed charges,814.72,1748.8,
DRILL BIT 03133101,5801832,CDM,272,RC,,,Outpatient,,,513,410.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,410.4,80,,328.32,percent of total billed charges,80% of total billed charges,191.2,37.27,,152.96,percent of total billed charges,37.27% of total billed charges,191.2,37.27,,152.96,percent of total billed charges,37.27% of total billed charges,191.2,37.27,,152.96,percent of total billed charges,37.27% 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,205.2,40,,164.16,percent of total billed charges,40% of total billed charges,191.2,410.4,
PLATE WRIST 04110151,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5447,4357.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4357.6,80,,3486.08,percent of total billed charges,80% of total billed charges,2030.1,37.27,,1624.08,percent of total billed charges,37.27% of total billed charges,2030.1,37.27,,1624.08,percent of total billed charges,37.27% of total billed charges,2030.1,37.27,,1624.08,percent of total billed charges,37.27% 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,2178.8,40,,1743.04,percent of total billed charges,40% of total billed charges,2030.1,4357.6,
SCREW 404818,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% 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,28,40,,22.4,percent of total billed charges,40% of total billed charges,26.09,56,
SCREW 404814,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% 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,28,40,,22.4,percent of total billed charges,40% of total billed charges,26.09,56,
SCREW 404820,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% 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,28,40,,22.4,percent of total billed charges,40% of total billed charges,26.09,56,
SCREW 404828,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,70,56.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,80,,44.8,percent of total billed charges,80% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% of total billed charges,26.09,37.27,,20.87,percent of total billed charges,37.27% 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,28,40,,22.4,percent of total billed charges,40% of total billed charges,26.09,56,
SCREW 402818,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,126,100.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% 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,50.4,40,,40.32,percent of total billed charges,40% of total billed charges,46.96,100.8,
SCREW 402824,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,126,100.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% 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,50.4,40,,40.32,percent of total billed charges,40% of total billed charges,46.96,100.8,
SCREW 402820,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,126,100.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% 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,50.4,40,,40.32,percent of total billed charges,40% of total billed charges,46.96,100.8,
SCREW 402814,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,126,100.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100.8,80,,80.64,percent of total billed charges,80% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% of total billed charges,46.96,37.27,,37.57,percent of total billed charges,37.27% 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,50.4,40,,40.32,percent of total billed charges,40% of total billed charges,46.96,100.8,
SCREW 201760,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,426,340.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,340.8,80,,272.64,percent of total billed charges,80% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% 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,170.4,40,,136.32,percent of total billed charges,40% of total billed charges,158.77,340.8,
PLATE 247375,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2679,2143.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2143.2,80,,1714.56,percent of total billed charges,80% of total billed charges,998.46,37.27,,798.77,percent of total billed charges,37.27% of total billed charges,998.46,37.27,,798.77,percent of total billed charges,37.27% of total billed charges,998.46,37.27,,798.77,percent of total billed charges,37.27% 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,1071.6,40,,857.28,percent of total billed charges,40% of total billed charges,998.46,2143.2,
SCREW 4X50 604650S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,546,436.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,436.8,80,,349.44,percent of total billed charges,80% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% 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,218.4,40,,174.72,percent of total billed charges,40% of total billed charges,203.49,436.8,
DRILL BIT 703690,5801832,CDM,272,RC,,,Outpatient,,,570,456.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,456,80,,364.8,percent of total billed charges,80% of total billed charges,212.44,37.27,,169.95,percent of total billed charges,37.27% of total billed charges,212.44,37.27,,169.95,percent of total billed charges,37.27% of total billed charges,212.44,37.27,,169.95,percent of total billed charges,37.27% 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,228,40,,182.4,percent of total billed charges,40% of total billed charges,212.44,456,
SCREW 2.7X32 657132,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,331,264.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264.8,80,,211.84,percent of total billed charges,80% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% 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,132.4,40,,105.92,percent of total billed charges,40% of total billed charges,123.36,264.8,
SCREW 2.7X44 657144,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,331,264.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264.8,80,,211.84,percent of total billed charges,80% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% 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,132.4,40,,105.92,percent of total billed charges,40% of total billed charges,123.36,264.8,
DBM 1CC 81030201S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,413,330.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% 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,165.2,40,,132.16,percent of total billed charges,40% of total billed charges,153.93,330.4,
DRILL BIT 703691,5801832,CDM,272,RC,,,Outpatient,,,436,348.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,348.8,80,,279.04,percent of total billed charges,80% of total billed charges,162.5,37.27,,130,percent of total billed charges,37.27% of total billed charges,162.5,37.27,,130,percent of total billed charges,37.27% of total billed charges,162.5,37.27,,130,percent of total billed charges,37.27% 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,174.4,40,,139.52,percent of total billed charges,40% of total billed charges,162.5,348.8,
SCREW 3.5X12 657430,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,254,203.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203.2,80,,162.56,percent of total billed charges,80% of total billed charges,94.67,37.27,,75.74,percent of total billed charges,37.27% of total billed charges,94.67,37.27,,75.74,percent of total billed charges,37.27% of total billed charges,94.67,37.27,,75.74,percent of total billed charges,37.27% 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,101.6,40,,81.28,percent of total billed charges,40% of total billed charges,94.67,203.2,
SCREW 3.5X46 657446,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,254,203.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,203.2,80,,162.56,percent of total billed charges,80% of total billed charges,94.67,37.27,,75.74,percent of total billed charges,37.27% of total billed charges,94.67,37.27,,75.74,percent of total billed charges,37.27% of total billed charges,94.67,37.27,,75.74,percent of total billed charges,37.27% 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,101.6,40,,81.28,percent of total billed charges,40% of total billed charges,94.67,203.2,
PLATE 6H FIB 4020906,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1415,1132.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1132,80,,905.6,percent of total billed charges,80% of total billed charges,527.37,37.27,,421.9,percent of total billed charges,37.27% of total billed charges,527.37,37.27,,421.9,percent of total billed charges,37.27% of total billed charges,527.37,37.27,,421.9,percent of total billed charges,37.27% 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,566,40,,452.8,percent of total billed charges,40% of total billed charges,527.37,1132,
TRI TIB 5536B400,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4400,3520.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3520,80,,2816,percent of total billed charges,80% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% 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,1760,40,,1408,percent of total billed charges,40% of total billed charges,1639.88,3520,
TRI TIB 5530G409E,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
VIVIGEN BONE MED,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,7590,6072.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6072,80,,4857.6,percent of total billed charges,80% of total billed charges,2828.79,37.27,,2263.03,percent of total billed charges,37.27% of total billed charges,2828.79,37.27,,2263.03,percent of total billed charges,37.27% of total billed charges,2828.79,37.27,,2263.03,percent of total billed charges,37.27% 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,3036,40,,2428.8,percent of total billed charges,40% of total billed charges,2828.79,6072,
SPA 365706CS,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2338,1870.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1870.4,80,,1496.32,percent of total billed charges,80% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% 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,935.2,40,,748.16,percent of total billed charges,40% of total billed charges,871.37,1870.4,
PLATE 1L 161114,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2613,2090.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.4,80,,1672.32,percent of total billed charges,80% of total billed charges,973.87,37.27,,779.1,percent of total billed charges,37.27% of total billed charges,973.87,37.27,,779.1,percent of total billed charges,37.27% of total billed charges,973.87,37.27,,779.1,percent of total billed charges,37.27% 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,1045.2,40,,836.16,percent of total billed charges,40% of total billed charges,973.87,2090.4,
DISTRACT PIN 601012,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,144,115.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,115.2,80,,92.16,percent of total billed charges,80% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% of total billed charges,53.67,37.27,,42.94,percent of total billed charges,37.27% 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,57.6,40,,46.08,percent of total billed charges,40% of total billed charges,53.67,115.2,
SCREW 2.7X40 657140,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,331,264.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264.8,80,,211.84,percent of total billed charges,80% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% 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,132.4,40,,105.92,percent of total billed charges,40% of total billed charges,123.36,264.8,
SCREW 2.7X42 657142,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,331,264.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264.8,80,,211.84,percent of total billed charges,80% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% 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,132.4,40,,105.92,percent of total billed charges,40% of total billed charges,123.36,264.8,
SCREW 204824,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,176,140.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140.8,80,,112.64,percent of total billed charges,80% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% of total billed charges,65.6,37.27,,52.48,percent of total billed charges,37.27% 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,70.4,40,,56.32,percent of total billed charges,40% of total billed charges,65.6,140.8,
SCREW 206014,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,204,163.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,163.2,80,,130.56,percent of total billed charges,80% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% of total billed charges,76.03,37.27,,60.82,percent of total billed charges,37.27% 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,81.6,40,,65.28,percent of total billed charges,40% of total billed charges,76.03,163.2,
CANNULA AR-6540,5801832,CDM,272,RC,,,Outpatient,,,69,55.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% 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,27.6,40,,22.08,percent of total billed charges,40% of total billed charges,25.72,55.2,
FEM CRUCIATE 940023,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,7868,6294.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6294.4,80,,5035.52,percent of total billed charges,80% of total billed charges,2932.4,37.27,,2345.92,percent of total billed charges,37.27% of total billed charges,2932.4,37.27,,2345.92,percent of total billed charges,37.27% of total billed charges,2932.4,37.27,,2345.92,percent of total billed charges,37.27% 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,3147.2,40,,2517.76,percent of total billed charges,40% of total billed charges,2932.4,6294.4,
TROPE AR1288QT100,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2681,2144.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2144.8,80,,1715.84,percent of total billed charges,80% of total billed charges,999.21,37.27,,799.37,percent of total billed charges,37.27% of total billed charges,999.21,37.27,,799.37,percent of total billed charges,37.27% of total billed charges,999.21,37.27,,799.37,percent of total billed charges,37.27% 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,1072.4,40,,857.92,percent of total billed charges,40% of total billed charges,999.21,2144.8,
SCREW AR1390C,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,646,516.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,516.8,80,,413.44,percent of total billed charges,80% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% of total billed charges,240.76,37.27,,192.61,percent of total billed charges,37.27% 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,258.4,40,,206.72,percent of total billed charges,40% of total billed charges,240.76,516.8,
ACET SHELL 121732058,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4663,3730.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3730.4,80,,2984.32,percent of total billed charges,80% of total billed charges,1737.9,37.27,,1390.32,percent of total billed charges,37.27% of total billed charges,1737.9,37.27,,1390.32,percent of total billed charges,37.27% of total billed charges,1737.9,37.27,,1390.32,percent of total billed charges,37.27% 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,1865.2,40,,1492.16,percent of total billed charges,40% of total billed charges,1737.9,3730.4,
FEM HEAD 136536320,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2481,1984.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1984.8,80,,1587.84,percent of total billed charges,80% of total billed charges,924.67,37.27,,739.74,percent of total billed charges,37.27% of total billed charges,924.67,37.27,,739.74,percent of total billed charges,37.27% of total billed charges,924.67,37.27,,739.74,percent of total billed charges,37.27% 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,992.4,40,,793.92,percent of total billed charges,40% of total billed charges,924.67,1984.8,
SCREW 121725500,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
FEM STEM 157002120,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3864,3091.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3091.2,80,,2472.96,percent of total billed charges,80% of total billed charges,1440.11,37.27,,1152.09,percent of total billed charges,37.27% of total billed charges,1440.11,37.27,,1152.09,percent of total billed charges,37.27% of total billed charges,1440.11,37.27,,1152.09,percent of total billed charges,37.27% 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,1545.6,40,,1236.48,percent of total billed charges,40% of total billed charges,1440.11,3091.2,
ACET LINER 122136058,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2272,1817.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1817.6,80,,1454.08,percent of total billed charges,80% of total billed charges,846.77,37.27,,677.42,percent of total billed charges,37.27% of total billed charges,846.77,37.27,,677.42,percent of total billed charges,37.27% of total billed charges,846.77,37.27,,677.42,percent of total billed charges,37.27% 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,908.8,40,,727.04,percent of total billed charges,40% of total billed charges,846.77,1817.6,
LEQVIO 284MG,6065130,CDM,636,RC,J1306,HCPCS,Outpatient,,,6284.65,5027.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5027.72,80,,4022.18,percent of total billed charges,80% of total billed charges,2342.29,37.27,,1873.83,percent of total billed charges,37.27% of total billed charges,2342.29,37.27,,1873.83,percent of total billed charges,37.27% of total billed charges,2342.29,37.27,,1873.83,percent of total billed charges,37.27% of total billed charges,12.19,100,,,fee schedule,100% of APC rate,12.19,100,,,fee schedule,100% of APC rate,12.19,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,12.19,100,,,fee schedule,100% of APC rate,12.19,100,,,fee schedule,100% of APC rate,12.19,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2513.86,40,,2011.09,percent of total billed charges,40% of total billed charges,12.19,5027.72,
DBM PUTTY 1CC 810300,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,413,330.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% 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,165.2,40,,132.16,percent of total billed charges,40% of total billed charges,153.93,330.4,
SCREW 161012,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,344,275.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,128.21,37.27,,102.57,percent of total billed charges,37.27% of total billed charges,128.21,37.27,,102.57,percent of total billed charges,37.27% of total billed charges,128.21,37.27,,102.57,percent of total billed charges,37.27% 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,137.6,40,,110.08,percent of total billed charges,40% of total billed charges,128.21,275.2,
PLATE 161228,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3176,2540.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2540.8,80,,2032.64,percent of total billed charges,80% of total billed charges,1183.7,37.27,,946.96,percent of total billed charges,37.27% of total billed charges,1183.7,37.27,,946.96,percent of total billed charges,37.27% of total billed charges,1183.7,37.27,,946.96,percent of total billed charges,37.27% 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,1270.4,40,,1016.32,percent of total billed charges,40% of total billed charges,1183.7,2540.8,
TIB INSERT 196192033,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3713,2970.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2970.4,80,,2376.32,percent of total billed charges,80% of total billed charges,1383.84,37.27,,1107.07,percent of total billed charges,37.27% of total billed charges,1383.84,37.27,,1107.07,percent of total billed charges,37.27% of total billed charges,1383.84,37.27,,1107.07,percent of total billed charges,37.27% 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,1485.2,40,,1188.16,percent of total billed charges,40% of total billed charges,1383.84,2970.4,
TIB ROT 129433125,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4983,3986.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3986.4,80,,3189.12,percent of total billed charges,80% of total billed charges,1857.16,37.27,,1485.73,percent of total billed charges,37.27% of total billed charges,1857.16,37.27,,1485.73,percent of total billed charges,37.27% of total billed charges,1857.16,37.27,,1485.73,percent of total billed charges,37.27% 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,1993.2,40,,1594.56,percent of total billed charges,40% of total billed charges,1857.16,3986.4,
LNT SYS AR1665BCSL,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2200,1760.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1760,80,,1408,percent of total billed charges,80% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% 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,880,40,,704,percent of total billed charges,40% of total billed charges,819.94,1760,
RETROCUT AR1204R095S,5801832,CDM,272,RC,,,Outpatient,,,536,428.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428.8,80,,343.04,percent of total billed charges,80% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% 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,214.4,40,,171.52,percent of total billed charges,40% of total billed charges,199.77,428.8,
RETROGUIDE AR1250RP,5801832,CDM,272,RC,,,Outpatient,,,399,319.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,319.2,80,,255.36,percent of total billed charges,80% of total billed charges,148.71,37.27,,118.97,percent of total billed charges,37.27% of total billed charges,148.71,37.27,,118.97,percent of total billed charges,37.27% of total billed charges,148.71,37.27,,118.97,percent of total billed charges,37.27% 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,159.6,40,,127.68,percent of total billed charges,40% of total billed charges,148.71,319.2,
TROPE AR1588BTB2J,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1499,1199.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1199.2,80,,959.36,percent of total billed charges,80% of total billed charges,558.68,37.27,,446.94,percent of total billed charges,37.27% of total billed charges,558.68,37.27,,446.94,percent of total billed charges,37.27% of total billed charges,558.68,37.27,,446.94,percent of total billed charges,37.27% 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,599.6,40,,479.68,percent of total billed charges,40% of total billed charges,558.68,1199.2,
TROPE AR1588TB4,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,450,360.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,360,80,,288,percent of total billed charges,80% of total billed charges,167.72,37.27,,134.18,percent of total billed charges,37.27% of total billed charges,167.72,37.27,,134.18,percent of total billed charges,37.27% of total billed charges,167.72,37.27,,134.18,percent of total billed charges,37.27% 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,180,40,,144,percent of total billed charges,40% of total billed charges,167.72,360,
TROPE AR1588TN21,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,811,648.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,648.8,80,,519.04,percent of total billed charges,80% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% 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,324.4,40,,259.52,percent of total billed charges,40% of total billed charges,302.26,648.8,
FIXATN BIOS AR1593BC,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1994,1595.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1595.2,80,,1276.16,percent of total billed charges,80% of total billed charges,743.16,37.27,,594.53,percent of total billed charges,37.27% of total billed charges,743.16,37.27,,594.53,percent of total billed charges,37.27% of total billed charges,743.16,37.27,,594.53,percent of total billed charges,37.27% 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,797.6,40,,638.08,percent of total billed charges,40% of total billed charges,743.16,1595.2,
SPA365405CS,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2338,1870.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1870.4,80,,1496.32,percent of total billed charges,80% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% of total billed charges,871.37,37.27,,697.1,percent of total billed charges,37.27% 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,935.2,40,,748.16,percent of total billed charges,40% of total billed charges,871.37,1870.4,
SPA 365408CS,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2337,1869.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1869.6,80,,1495.68,percent of total billed charges,80% of total billed charges,871,37.27,,696.8,percent of total billed charges,37.27% of total billed charges,871,37.27,,696.8,percent of total billed charges,37.27% of total billed charges,871,37.27,,696.8,percent of total billed charges,37.27% 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,934.8,40,,747.84,percent of total billed charges,40% of total billed charges,871,1869.6,
DISSECT TOOL 14MH30,5801832,CDM,272,RC,,,Outpatient,,,197,157.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,157.6,80,,126.08,percent of total billed charges,80% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% of total billed charges,73.42,37.27,,58.74,percent of total billed charges,37.27% 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,78.8,40,,63.04,percent of total billed charges,40% of total billed charges,73.42,157.6,
DISSECT TOOL T12MH25,5801832,CDM,272,RC,,,Outpatient,,,266,212.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,212.8,80,,170.24,percent of total billed charges,80% of total billed charges,99.14,37.27,,79.31,percent of total billed charges,37.27% of total billed charges,99.14,37.27,,79.31,percent of total billed charges,37.27% of total billed charges,99.14,37.27,,79.31,percent of total billed charges,37.27% 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,106.4,40,,85.12,percent of total billed charges,40% of total billed charges,99.14,212.8,
CT LUNG CANCER SCREE,6010052,CDM,350,RC,71271,HCPCS,Outpatient,,,1645,1316.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,114.84,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,90.64,1316,
CT BONE MINERAL DENS,6010052,CDM,350,RC,77078,HCPCS,Outpatient,,,1645,1316.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,116.39,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,74.92,1316,
PUTTY KOR 5CC 423205,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3414,2731.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2731.2,80,,2184.96,percent of total billed charges,80% of total billed charges,1272.4,37.27,,1017.92,percent of total billed charges,37.27% of total billed charges,1272.4,37.27,,1017.92,percent of total billed charges,37.27% of total billed charges,1272.4,37.27,,1017.92,percent of total billed charges,37.27% 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,1365.6,40,,1092.48,percent of total billed charges,40% of total billed charges,1272.4,2731.2,
DBM PUTTY 1CC 421010,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,346,276.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,276.8,80,,221.44,percent of total billed charges,80% of total billed charges,128.95,37.27,,103.16,percent of total billed charges,37.27% of total billed charges,128.95,37.27,,103.16,percent of total billed charges,37.27% of total billed charges,128.95,37.27,,103.16,percent of total billed charges,37.27% 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,138.4,40,,110.72,percent of total billed charges,40% of total billed charges,128.95,276.8,
DBM PTY 2.5CC 421025,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,811,648.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,648.8,80,,519.04,percent of total billed charges,80% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% 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,324.4,40,,259.52,percent of total billed charges,40% of total billed charges,302.26,648.8,
VIRTUAL ER MEDSURG R,13003,CDM,110,RC,,,Inpatient,,,778,622.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,622.4,80,,497.92,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,622.4,622.4,
VIRTUAL ER ICU RM,12005,CDM,200,RC,,,Inpatient,,,1946,1556.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1556.8,80,,1245.44,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,1556.8,1556.8,
VIRTUAL ER OB ROOM,14001,CDM,112,RC,,,Inpatient,,,649,519.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,519.2,80,,415.36,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,519.2,519.2,
VIRTUAL ER TELE ICU,22004,CDM,206,RC,,,Inpatient,,,1297,1037.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1037.6,80,,830.08,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,1037.6,1037.6,
VIRTUAL ER TELE MS,22004,CDM,206,RC,,,Inpatient,,,1297,1037.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1037.6,80,,830.08,percent of total billed charges,80% 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,,,,,other ,not seperately reimbursable,1037.6,1037.6,
CATHFLO 2MG,6065130,CDM,636,RC,,,Outpatient,,,626.3,501.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,501.04,80,,400.83,percent of total billed charges,80% of total billed charges,233.42,37.27,,186.74,percent of total billed charges,37.27% of total billed charges,233.42,37.27,,186.74,percent of total billed charges,37.27% of total billed charges,233.42,37.27,,186.74,percent of total billed charges,37.27% 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,250.52,40,,200.42,percent of total billed charges,40% of total billed charges,233.42,501.04,
SURGI HEMOROID TAMPO,5645742,CDM,270,RC,,,Outpatient,,,105,84.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% 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,42,40,,33.6,percent of total billed charges,40% of total billed charges,39.13,84,
PLATE 626672,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,954,763.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,763.2,80,,610.56,percent of total billed charges,80% of total billed charges,355.56,37.27,,284.45,percent of total billed charges,37.27% of total billed charges,355.56,37.27,,284.45,percent of total billed charges,37.27% of total billed charges,355.56,37.27,,284.45,percent of total billed charges,37.27% 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,381.6,40,,305.28,percent of total billed charges,40% of total billed charges,355.56,763.2,
SCREW 657455,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,331,264.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264.8,80,,211.84,percent of total billed charges,80% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% 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,132.4,40,,105.92,percent of total billed charges,40% of total billed charges,123.36,264.8,
SCREW 657460,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,331,264.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264.8,80,,211.84,percent of total billed charges,80% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% 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,132.4,40,,105.92,percent of total billed charges,40% of total billed charges,123.36,264.8,
PEDIGUARD P2HE1000,8605396,CDM,278,RC,C1734,HCPCS,Outpatient,,,3988,3190.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3190.4,80,,2552.32,percent of total billed charges,80% of total billed charges,1486.33,37.27,,1189.06,percent of total billed charges,37.27% of total billed charges,1486.33,37.27,,1189.06,percent of total billed charges,37.27% of total billed charges,1486.33,37.27,,1189.06,percent of total billed charges,37.27% 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,1595.2,40,,1276.16,percent of total billed charges,40% of total billed charges,1486.33,3190.4,
PEDIGUARD P2ND1001,8605396,CDM,278,RC,C1734,HCPCS,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
PEDIGUARD P2ST1060,8605396,CDM,278,RC,C1734,HCPCS,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
SURGIFOAM 8X12,5645742,CDM,270,RC,,,Outpatient,,,105,84.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% 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,42,40,,33.6,percent of total billed charges,40% of total billed charges,39.13,84,
MESH RECT 30X20,8605396,CDM,278,RC,C1781,HCPCS,Outpatient,,,5281,4224.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4224.8,80,,3379.84,percent of total billed charges,80% of total billed charges,1968.23,37.27,,1574.58,percent of total billed charges,37.27% of total billed charges,1968.23,37.27,,1574.58,percent of total billed charges,37.27% of total billed charges,1968.23,37.27,,1574.58,percent of total billed charges,37.27% 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,2112.4,40,,1689.92,percent of total billed charges,40% of total billed charges,1968.23,4224.8,
SCREW 10674635,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1650,1320.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1320,80,,1056,percent of total billed charges,80% of total billed charges,614.96,37.27,,491.97,percent of total billed charges,37.27% of total billed charges,614.96,37.27,,491.97,percent of total billed charges,37.27% of total billed charges,614.96,37.27,,491.97,percent of total billed charges,37.27% 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,660,40,,528,percent of total billed charges,40% of total billed charges,614.96,1320,
SCREW 10674640,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1650,1320.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1320,80,,1056,percent of total billed charges,80% of total billed charges,614.96,37.27,,491.97,percent of total billed charges,37.27% of total billed charges,614.96,37.27,,491.97,percent of total billed charges,37.27% of total billed charges,614.96,37.27,,491.97,percent of total billed charges,37.27% 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,660,40,,528,percent of total billed charges,40% of total billed charges,614.96,1320,
CAP LOCKING 11340010,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,275,220.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
TULIP 11340100,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1100,880.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,880,80,,704,percent of total billed charges,80% of total billed charges,409.97,37.27,,327.98,percent of total billed charges,37.27% of total billed charges,409.97,37.27,,327.98,percent of total billed charges,37.27% of total billed charges,409.97,37.27,,327.98,percent of total billed charges,37.27% 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,440,40,,352,percent of total billed charges,40% of total billed charges,409.97,880,
SPACER 11722021S,8605396,CDM,278,RC,C1734,HCPCS,Outpatient,,,17875,14300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14300,80,,11440,percent of total billed charges,80% of total billed charges,6662.01,37.27,,5329.61,percent of total billed charges,37.27% of total billed charges,6662.01,37.27,,5329.61,percent of total billed charges,37.27% of total billed charges,6662.01,37.27,,5329.61,percent of total billed charges,37.27% 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,7150,40,,5720,percent of total billed charges,40% of total billed charges,6662.01,14300,
SPACER11724113S,8605396,CDM,278,RC,C1734,HCPCS,Outpatient,,,17875,14300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14300,80,,11440,percent of total billed charges,80% of total billed charges,6662.01,37.27,,5329.61,percent of total billed charges,37.27% of total billed charges,6662.01,37.27,,5329.61,percent of total billed charges,37.27% of total billed charges,6662.01,37.27,,5329.61,percent of total billed charges,37.27% 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,7150,40,,5720,percent of total billed charges,40% of total billed charges,6662.01,14300,
ROD 132185,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1788,1430.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1430.4,80,,1144.32,percent of total billed charges,80% of total billed charges,666.39,37.27,,533.11,percent of total billed charges,37.27% of total billed charges,666.39,37.27,,533.11,percent of total billed charges,37.27% of total billed charges,666.39,37.27,,533.11,percent of total billed charges,37.27% 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,715.2,40,,572.16,percent of total billed charges,40% of total billed charges,666.39,1430.4,
KNIFE 675405S,8605396,CDM,278,RC,,,Outpatient,,,1650,1320.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1320,80,,1056,percent of total billed charges,80% of total billed charges,614.96,37.27,,491.97,percent of total billed charges,37.27% of total billed charges,614.96,37.27,,491.97,percent of total billed charges,37.27% of total billed charges,614.96,37.27,,491.97,percent of total billed charges,37.27% 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,660,40,,528,percent of total billed charges,40% of total billed charges,614.96,1320,
K WIRE 685007,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,536,428.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428.8,80,,343.04,percent of total billed charges,80% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% 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,214.4,40,,171.52,percent of total billed charges,40% of total billed charges,199.77,428.8,
AEROBIKA SYSTEM,5645742,CDM,270,RC,,,Outpatient,,,134,107.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% 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,53.6,40,,42.88,percent of total billed charges,40% of total billed charges,49.94,107.2,
VERSED PREMIX DRIP,6065130,CDM,636,RC,J2250,HCPCS,Outpatient,,,119.1,95.28,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,95.28,80,,76.22,percent of total billed charges,80% of total billed charges,44.39,37.27,,35.51,percent of total billed charges,37.27% of total billed charges,44.39,37.27,,35.51,percent of total billed charges,37.27% of total billed charges,44.39,37.27,,35.51,percent of total billed charges,37.27% 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,47.64,40,,38.11,percent of total billed charges,40% of total billed charges,44.39,95.28,
TENDON SPD001,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,6394,5115.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5115.2,80,,4092.16,percent of total billed charges,80% of total billed charges,2383.04,37.27,,1906.43,percent of total billed charges,37.27% of total billed charges,2383.04,37.27,,1906.43,percent of total billed charges,37.27% of total billed charges,2383.04,37.27,,1906.43,percent of total billed charges,37.27% 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,2557.6,40,,2046.08,percent of total billed charges,40% of total billed charges,2383.04,5115.2,
SWIVELOCK AR2324BCT2,5645742,CDM,270,RC,,,Outpatient,,,1169,935.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.2,80,,748.16,percent of total billed charges,80% of total billed charges,435.69,37.27,,348.55,percent of total billed charges,37.27% of total billed charges,435.69,37.27,,348.55,percent of total billed charges,37.27% of total billed charges,435.69,37.27,,348.55,percent of total billed charges,37.27% 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,467.6,40,,374.08,percent of total billed charges,40% of total billed charges,435.69,935.2,
SCR AR1381E,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,316,252.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% 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,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,117.77,252.8,
PLATE 1L 10MM161110,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2613,2090.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2090.4,80,,1672.32,percent of total billed charges,80% of total billed charges,973.87,37.27,,779.1,percent of total billed charges,37.27% of total billed charges,973.87,37.27,,779.1,percent of total billed charges,37.27% of total billed charges,973.87,37.27,,779.1,percent of total billed charges,37.27% 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,1045.2,40,,836.16,percent of total billed charges,40% of total billed charges,973.87,2090.4,
REMOVAL PICC/OSS,5612346,CDM,761,RC,36589,HCPCS,Outpatient,,,1285,1028.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1028,80,,822.4,percent of total billed charges,80% of total billed charges,478.92,37.27,,383.14,percent of total billed charges,37.27% of total billed charges,478.92,37.27,,383.14,percent of total billed charges,37.27% of total billed charges,478.92,37.27,,383.14,percent of total billed charges,37.27% of total billed charges,517.96,100,,,fee schedule,100% of APC rate,517.96,100,,,fee schedule,100% of APC rate,517.96,100,,,fee schedule,100% of APC rate,188.43,145,,,fee schedule,145% of CMS fee schedule,517.96,100,,,fee schedule,100% of APC rate,517.96,100,,,fee schedule,100% of APC rate,517.96,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,514,40,,411.2,percent of total billed charges,40% of total billed charges,188.43,1028,
SCREW 657422,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,331,264.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264.8,80,,211.84,percent of total billed charges,80% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% 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,132.4,40,,105.92,percent of total billed charges,40% of total billed charges,123.36,264.8,
SUTURETAPE AR7500,5801832,CDM,272,RC,,,Outpatient,,,96,76.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% 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,38.4,40,,30.72,percent of total billed charges,40% of total billed charges,35.78,76.8,
HIP ACETA 122136156,8605396,CDM,278,RC,,,Outpatient,,,2272,1817.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1817.6,80,,1454.08,percent of total billed charges,80% of total billed charges,846.77,37.27,,677.42,percent of total billed charges,37.27% of total billed charges,846.77,37.27,,677.42,percent of total billed charges,37.27% of total billed charges,846.77,37.27,,677.42,percent of total billed charges,37.27% 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,908.8,40,,727.04,percent of total billed charges,40% of total billed charges,846.77,1817.6,
FEM STEM 155402180,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4881,3904.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3904.8,80,,3123.84,percent of total billed charges,80% of total billed charges,1819.15,37.27,,1455.32,percent of total billed charges,37.27% of total billed charges,1819.15,37.27,,1455.32,percent of total billed charges,37.27% of total billed charges,1819.15,37.27,,1455.32,percent of total billed charges,37.27% 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,1952.4,40,,1561.92,percent of total billed charges,40% of total billed charges,1819.15,3904.8,
FEM HEAD 13536730,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,16049,12839.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12839.2,80,,10271.36,percent of total billed charges,80% of total billed charges,5981.46,37.27,,4785.17,percent of total billed charges,37.27% of total billed charges,5981.46,37.27,,4785.17,percent of total billed charges,37.27% of total billed charges,5981.46,37.27,,4785.17,percent of total billed charges,37.27% 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,6419.6,40,,5135.68,percent of total billed charges,40% of total billed charges,5981.46,12839.2,
FIBERWIRE AR7201,5801832,CDM,272,RC,,,Outpatient,,,677,541.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,541.6,80,,433.28,percent of total billed charges,80% of total billed charges,252.32,37.27,,201.86,percent of total billed charges,37.27% of total billed charges,252.32,37.27,,201.86,percent of total billed charges,37.27% of total billed charges,252.32,37.27,,201.86,percent of total billed charges,37.27% 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,270.8,40,,216.64,percent of total billed charges,40% of total billed charges,252.32,541.6,
ADSON BI FORCEP DISP,5801832,CDM,272,RC,,,Outpatient,,,196,156.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,156.8,80,,125.44,percent of total billed charges,80% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% of total billed charges,73.05,37.27,,58.44,percent of total billed charges,37.27% 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,78.4,40,,62.72,percent of total billed charges,40% of total billed charges,73.05,156.8,
DALIRESP 250MCG TAB,5880901,CDM,637,RC,,,Outpatient,,,60.5,48.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.4,80,,38.72,percent of total billed charges,80% of total billed charges,22.55,37.27,,18.04,percent of total billed charges,37.27% of total billed charges,22.55,37.27,,18.04,percent of total billed charges,37.27% of total billed charges,22.55,37.27,,18.04,percent of total billed charges,37.27% 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,24.2,40,,19.36,percent of total billed charges,40% of total billed charges,22.55,48.4,
PROTOE IMP 1704958,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3248,2598.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2598.4,80,,2078.72,percent of total billed charges,80% of total billed charges,1210.53,37.27,,968.42,percent of total billed charges,37.27% of total billed charges,1210.53,37.27,,968.42,percent of total billed charges,37.27% of total billed charges,1210.53,37.27,,968.42,percent of total billed charges,37.27% 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,1299.2,40,,1039.36,percent of total billed charges,40% of total billed charges,1210.53,2598.4,
PROTOE INST 45710500,5801832,CDM,272,RC,,,Outpatient,,,1243,994.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,994.4,80,,795.52,percent of total billed charges,80% of total billed charges,463.27,37.27,,370.62,percent of total billed charges,37.27% of total billed charges,463.27,37.27,,370.62,percent of total billed charges,37.27% of total billed charges,463.27,37.27,,370.62,percent of total billed charges,37.27% 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,497.2,40,,397.76,percent of total billed charges,40% of total billed charges,463.27,994.4,
DRILL BIT 32486265,5801832,CDM,272,RC,,,Outpatient,,,497,397.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,397.6,80,,318.08,percent of total billed charges,80% of total billed charges,185.23,37.27,,148.18,percent of total billed charges,37.27% of total billed charges,185.23,37.27,,148.18,percent of total billed charges,37.27% of total billed charges,185.23,37.27,,148.18,percent of total billed charges,37.27% 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,198.8,40,,159.04,percent of total billed charges,40% of total billed charges,185.23,397.6,
SAW BLADE 506298,5801832,CDM,272,RC,,,Outpatient,,,1238,990.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,990.4,80,,792.32,percent of total billed charges,80% of total billed charges,461.4,37.27,,369.12,percent of total billed charges,37.27% of total billed charges,461.4,37.27,,369.12,percent of total billed charges,37.27% of total billed charges,461.4,37.27,,369.12,percent of total billed charges,37.27% 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,495.2,40,,396.16,percent of total billed charges,40% of total billed charges,461.4,990.4,
KNEE TIB MED 154725,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3465,2772.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2772,80,,2217.6,percent of total billed charges,80% of total billed charges,1291.41,37.27,,1033.13,percent of total billed charges,37.27% of total billed charges,1291.41,37.27,,1033.13,percent of total billed charges,37.27% of total billed charges,1291.41,37.27,,1033.13,percent of total billed charges,37.27% 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,1386,40,,1108.8,percent of total billed charges,40% of total billed charges,1291.41,2772,
KNEE TIB MED 159576,8605396,CDM,278,RC,C1777,HCPCS,Outpatient,,,3465,2772.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2772,80,,2217.6,percent of total billed charges,80% of total billed charges,1291.41,37.27,,1033.13,percent of total billed charges,37.27% of total billed charges,1291.41,37.27,,1033.13,percent of total billed charges,37.27% of total billed charges,1291.41,37.27,,1033.13,percent of total billed charges,37.27% 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,1386,40,,1108.8,percent of total billed charges,40% of total billed charges,1291.41,2772,
BONE CEMENT 11003435,5801832,CDM,272,RC,,,Outpatient,,,536,428.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428.8,80,,343.04,percent of total billed charges,80% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% 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,214.4,40,,171.52,percent of total billed charges,40% of total billed charges,199.77,428.8,
KNEE FEM PEG 161469,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,6875,5500.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5500,80,,4400,percent of total billed charges,80% of total billed charges,2562.31,37.27,,2049.85,percent of total billed charges,37.27% of total billed charges,2562.31,37.27,,2049.85,percent of total billed charges,37.27% of total billed charges,2562.31,37.27,,2049.85,percent of total billed charges,37.27% 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,2750,40,,2200,percent of total billed charges,40% of total billed charges,2562.31,5500,
PLATE 3L 4800 161348,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3300,2640.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2640,80,,2112,percent of total billed charges,80% of total billed charges,1229.91,37.27,,983.93,percent of total billed charges,37.27% of total billed charges,1229.91,37.27,,983.93,percent of total billed charges,37.27% of total billed charges,1229.91,37.27,,983.93,percent of total billed charges,37.27% 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,1320,40,,1056,percent of total billed charges,40% of total billed charges,1229.91,2640,
SCREW 161016,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,344,275.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,275.2,80,,220.16,percent of total billed charges,80% of total billed charges,128.21,37.27,,102.57,percent of total billed charges,37.27% of total billed charges,128.21,37.27,,102.57,percent of total billed charges,37.27% of total billed charges,128.21,37.27,,102.57,percent of total billed charges,37.27% 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,137.6,40,,110.08,percent of total billed charges,40% of total billed charges,128.21,275.2,
FEM CRUCIATE 940025,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,7868,6294.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6294.4,80,,5035.52,percent of total billed charges,80% of total billed charges,2932.4,37.27,,2345.92,percent of total billed charges,37.27% of total billed charges,2932.4,37.27,,2345.92,percent of total billed charges,37.27% of total billed charges,2932.4,37.27,,2345.92,percent of total billed charges,37.27% 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,3147.2,40,,2517.76,percent of total billed charges,40% of total billed charges,2932.4,6294.4,
TIB INSERT 196192051,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3713,2970.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2970.4,80,,2376.32,percent of total billed charges,80% of total billed charges,1383.84,37.27,,1107.07,percent of total billed charges,37.27% of total billed charges,1383.84,37.27,,1107.07,percent of total billed charges,37.27% of total billed charges,1383.84,37.27,,1107.07,percent of total billed charges,37.27% 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,1485.2,40,,1188.16,percent of total billed charges,40% of total billed charges,1383.84,2970.4,
ENTYVIO 300MG,6065130,CDM,636,RC,J3380,HCPCS,Outpatient,,,23919.75,19135.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19135.8,80,,15308.64,percent of total billed charges,80% of total billed charges,8914.89,37.27,,7131.91,percent of total billed charges,37.27% of total billed charges,8914.89,37.27,,7131.91,percent of total billed charges,37.27% of total billed charges,8914.89,37.27,,7131.91,percent of total billed charges,37.27% of total billed charges,22.26,100,,,fee schedule,100% of APC rate,22.26,100,,,fee schedule,100% of APC rate,22.26,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,22.26,100,,,fee schedule,100% of APC rate,22.26,100,,,fee schedule,100% of APC rate,22.26,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9567.9,40,,7654.32,percent of total billed charges,40% of total billed charges,22.26,19135.8,
MAG SULFATE 40GM,6065130,CDM,636,RC,J3475,HCPCS,Outpatient,,,0.1,0.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.08,80,,0.06,percent of total billed charges,80% of total billed charges,0.04,37.27,,0.03,percent of total billed charges,37.27% of total billed charges,0.04,37.27,,0.03,percent of total billed charges,37.27% of total billed charges,0.04,37.27,,0.03,percent of total billed charges,37.27% 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,0.04,40,,0.03,percent of total billed charges,40% of total billed charges,0.04,0.08,
LOCKING CAP 11190010,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,275,220.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
ROD CVD 11197050,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,502,401.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,401.6,80,,321.28,percent of total billed charges,80% of total billed charges,187.1,37.27,,149.68,percent of total billed charges,37.27% of total billed charges,187.1,37.27,,149.68,percent of total billed charges,37.27% of total billed charges,187.1,37.27,,149.68,percent of total billed charges,37.27% 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,200.8,40,,160.64,percent of total billed charges,40% of total billed charges,187.1,401.6,
SCREW 51191642,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2200,1760.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1760,80,,1408,percent of total billed charges,80% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% 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,880,40,,704,percent of total billed charges,40% of total billed charges,819.94,1760,
SCREW 51191647,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2200,1760.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1760,80,,1408,percent of total billed charges,80% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% 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,880,40,,704,percent of total billed charges,40% of total billed charges,819.94,1760,
BUPIVACAINE 0.25% 50,6065130,CDM,636,RC,J0665,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,0.01,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,0.01,10.16,
PLATE 626676,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1028,822.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,822.4,80,,657.92,percent of total billed charges,80% of total billed charges,383.14,37.27,,306.51,percent of total billed charges,37.27% of total billed charges,383.14,37.27,,306.51,percent of total billed charges,37.27% of total billed charges,383.14,37.27,,306.51,percent of total billed charges,37.27% 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,411.2,40,,328.96,percent of total billed charges,40% of total billed charges,383.14,822.4,
SCREW 604636S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,546,436.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,436.8,80,,349.44,percent of total billed charges,80% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% 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,218.4,40,,174.72,percent of total billed charges,40% of total billed charges,203.49,436.8,
COUNTERSINK 4580040,5801832,CDM,272,RC,,,Outpatient,,,508,406.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,406.4,80,,325.12,percent of total billed charges,80% of total billed charges,189.33,37.27,,151.46,percent of total billed charges,37.27% of total billed charges,189.33,37.27,,151.46,percent of total billed charges,37.27% of total billed charges,189.33,37.27,,151.46,percent of total billed charges,37.27% 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,203.2,40,,162.56,percent of total billed charges,40% of total billed charges,189.33,406.4,
CT MAX-FAC SINUS W/C,6010052,CDM,350,RC,70487,HCPCS,Outpatient,,,1645,1316.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1316,80,,1052.8,percent of total billed charges,80% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,613.09,37.27,,490.47,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,131.33,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,658,40,,526.4,percent of total billed charges,40% of total billed charges,131.33,1316,
SCOLIOSIS SERIES 2-3,6000392,CDM,320,RC,72082,HCPCS,Outpatient,,,320,256.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256,80,,204.8,percent of total billed charges,80% of total billed charges,119.26,37.27,,95.41,percent of total billed charges,37.27% of total billed charges,119.26,37.27,,95.41,percent of total billed charges,37.27% of total billed charges,119.26,37.27,,95.41,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,70.31,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,40,,102.4,percent of total billed charges,40% of total billed charges,70.31,256,
SOD CHL 0.9%VIAL10ML,6400014,CDM,250,RC,J1205,HCPCS,Outpatient,,,12.7,10.16,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10.16,80,,8.13,percent of total billed charges,80% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% of total billed charges,4.73,37.27,,3.78,percent of total billed charges,37.27% 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,5.08,40,,4.06,percent of total billed charges,40% of total billed charges,4.73,10.16,
INSULIN 100U/NS100ML,6065130,CDM,636,RC,J1815,HCPCS,Outpatient,,,151.2,120.96,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120.96,80,,96.77,percent of total billed charges,80% of total billed charges,56.35,37.27,,45.08,percent of total billed charges,37.27% of total billed charges,56.35,37.27,,45.08,percent of total billed charges,37.27% of total billed charges,56.35,37.27,,45.08,percent of total billed charges,37.27% 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,60.48,40,,48.38,percent of total billed charges,40% of total billed charges,56.35,120.96,
KEPPRA 1000 INJ,6065130,CDM,636,RC,J1953,HCPCS,Outpatient,,,2.5,2.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2,80,,1.6,percent of total billed charges,80% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% of total billed charges,0.93,37.27,,0.74,percent of total billed charges,37.27% 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,1,40,,0.8,percent of total billed charges,40% of total billed charges,0.93,2,
NEBULIZER SUBSEQ TX,7439094,CDM,410,RC,94640,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,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,175.85,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,175.85,175.85,
SCREW 8X30 AR400C08,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,811,648.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,648.8,80,,519.04,percent of total billed charges,80% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% 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,324.4,40,,259.52,percent of total billed charges,40% of total billed charges,302.26,648.8,
SUT LASSO AR406825TR,5801832,CDM,272,RC,,,Outpatient,,,385,308.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,308,80,,246.4,percent of total billed charges,80% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% of total billed charges,143.49,37.27,,114.79,percent of total billed charges,37.27% 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,154,40,,123.2,percent of total billed charges,40% of total billed charges,143.49,308,
CANNULA AR6570,5645742,CDM,270,RC,,,Outpatient,,,69,55.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,55.2,80,,44.16,percent of total billed charges,80% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% of total billed charges,25.72,37.27,,20.58,percent of total billed charges,37.27% 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,27.6,40,,22.08,percent of total billed charges,40% of total billed charges,25.72,55.2,
EVOLVE STEM 496S455,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,8789,7031.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7031.2,80,,5624.96,percent of total billed charges,80% of total billed charges,3275.66,37.27,,2620.53,percent of total billed charges,37.27% of total billed charges,3275.66,37.27,,2620.53,percent of total billed charges,37.27% of total billed charges,3275.66,37.27,,2620.53,percent of total billed charges,37.27% 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,3515.6,40,,2812.48,percent of total billed charges,40% of total billed charges,3275.66,7031.2,
EVOLVE HEAD 496H218,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,7396,5916.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5916.8,80,,4733.44,percent of total billed charges,80% of total billed charges,2756.49,37.27,,2205.19,percent of total billed charges,37.27% of total billed charges,2756.49,37.27,,2205.19,percent of total billed charges,37.27% of total billed charges,2756.49,37.27,,2205.19,percent of total billed charges,37.27% 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,2958.4,40,,2366.72,percent of total billed charges,40% of total billed charges,2756.49,5916.8,
BONE CEMENT41292020S,5801832,CDM,272,RC,,,Outpatient,,,371,296.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,296.8,80,,237.44,percent of total billed charges,80% of total billed charges,138.27,37.27,,110.62,percent of total billed charges,37.27% of total billed charges,138.27,37.27,,110.62,percent of total billed charges,37.27% of total billed charges,138.27,37.27,,110.62,percent of total billed charges,37.27% 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,148.4,40,,118.72,percent of total billed charges,40% of total billed charges,138.27,296.8,
AFFIRM VCF 658924S,5801832,CDM,272,RC,,,Outpatient,,,10038,8030.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8030.4,80,,6424.32,percent of total billed charges,80% of total billed charges,3741.16,37.27,,2992.93,percent of total billed charges,37.27% of total billed charges,3741.16,37.27,,2992.93,percent of total billed charges,37.27% of total billed charges,3741.16,37.27,,2992.93,percent of total billed charges,37.27% 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,4015.2,40,,3212.16,percent of total billed charges,40% of total billed charges,3741.16,8030.4,
TROPE AR1288QT90,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2681,2144.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2144.8,80,,1715.84,percent of total billed charges,80% of total billed charges,999.21,37.27,,799.37,percent of total billed charges,37.27% of total billed charges,999.21,37.27,,799.37,percent of total billed charges,37.27% of total billed charges,999.21,37.27,,799.37,percent of total billed charges,37.27% 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,1072.4,40,,857.92,percent of total billed charges,40% of total billed charges,999.21,2144.8,
HARVESTER AR238611,5801832,CDM,272,RC,,,Outpatient,,,1169,935.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.2,80,,748.16,percent of total billed charges,80% of total billed charges,435.69,37.27,,348.55,percent of total billed charges,37.27% of total billed charges,435.69,37.27,,348.55,percent of total billed charges,37.27% of total billed charges,435.69,37.27,,348.55,percent of total billed charges,37.27% 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,467.6,40,,374.08,percent of total billed charges,40% of total billed charges,435.69,935.2,
SCREW 204818,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,198,158.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% 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,79.2,40,,63.36,percent of total billed charges,40% of total billed charges,73.79,158.4,
SCREW 204820,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,198,158.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% 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,79.2,40,,63.36,percent of total billed charges,40% of total billed charges,73.79,158.4,
PLATE 223561,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1703,1362.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1362.4,80,,1089.92,percent of total billed charges,80% of total billed charges,634.71,37.27,,507.77,percent of total billed charges,37.27% of total billed charges,634.71,37.27,,507.77,percent of total billed charges,37.27% of total billed charges,634.71,37.27,,507.77,percent of total billed charges,37.27% 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,681.2,40,,544.96,percent of total billed charges,40% of total billed charges,634.71,1362.4,
CIRCUMCISION SELFPAY,6466668,CDM,999,RC,,,Outpatient,,,150,120.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% 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,60,40,,48,percent of total billed charges,40% of total billed charges,55.91,120,
PERC  KT AR3610PK3,5645742,CDM,270,RC,,,Outpatient,,,619,495.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,495.2,80,,396.16,percent of total billed charges,80% of total billed charges,230.7,37.27,,184.56,percent of total billed charges,37.27% of total billed charges,230.7,37.27,,184.56,percent of total billed charges,37.27% of total billed charges,230.7,37.27,,184.56,percent of total billed charges,37.27% 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,247.6,40,,198.08,percent of total billed charges,40% of total billed charges,230.7,495.2,
FIBERTAK AR3636,5645742,CDM,270,RC,,,Outpatient,,,1210,968.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,968,80,,774.4,percent of total billed charges,80% of total billed charges,450.97,37.27,,360.78,percent of total billed charges,37.27% of total billed charges,450.97,37.27,,360.78,percent of total billed charges,37.27% of total billed charges,450.97,37.27,,360.78,percent of total billed charges,37.27% 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,484,40,,387.2,percent of total billed charges,40% of total billed charges,450.97,968,
SUT LASSO AR406590S,5645742,CDM,270,RC,,,Outpatient,,,316,252.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% 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,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,117.77,252.8,
KNEE BEAR 159575,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5239,4191.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4191.2,80,,3352.96,percent of total billed charges,80% of total billed charges,1952.58,37.27,,1562.06,percent of total billed charges,37.27% of total billed charges,1952.58,37.27,,1562.06,percent of total billed charges,37.27% of total billed charges,1952.58,37.27,,1562.06,percent of total billed charges,37.27% 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,2095.6,40,,1676.48,percent of total billed charges,40% of total billed charges,1952.58,4191.2,
SCREW IH2510,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1092,873.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,873.6,80,,698.88,percent of total billed charges,80% of total billed charges,406.99,37.27,,325.59,percent of total billed charges,37.27% of total billed charges,406.99,37.27,,325.59,percent of total billed charges,37.27% of total billed charges,406.99,37.27,,325.59,percent of total billed charges,37.27% 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,436.8,40,,349.44,percent of total billed charges,40% of total billed charges,406.99,873.6,
K WIRE KM115,5645742,CDM,270,RC,,,Outpatient,,,134,107.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% 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,53.6,40,,42.88,percent of total billed charges,40% of total billed charges,49.94,107.2,
DRILL BIT IS1112,5645742,CDM,270,RC,,,Outpatient,,,942,753.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,753.6,80,,602.88,percent of total billed charges,80% of total billed charges,351.08,37.27,,280.86,percent of total billed charges,37.27% of total billed charges,351.08,37.27,,280.86,percent of total billed charges,37.27% of total billed charges,351.08,37.27,,280.86,percent of total billed charges,37.27% 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,376.8,40,,301.44,percent of total billed charges,40% of total billed charges,351.08,753.6,
BEBTELOVIMAB 175 MG,6065130,CDM,636,RC,Q0222,HCPCS,Outpatient,,,2898,2318.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2318.4,80,,1854.72,percent of total billed charges,80% of total billed charges,1080.08,37.27,,864.06,percent of total billed charges,37.27% of total billed charges,1080.08,37.27,,864.06,percent of total billed charges,37.27% of total billed charges,1080.08,37.27,,864.06,percent of total billed charges,37.27% of total billed charges,2071.67,100,,,fee schedule,100% of APC rate,2071.67,100,,,fee schedule,100% of APC rate,2071.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,2071.67,100,,,fee schedule,100% of APC rate,2071.67,100,,,fee schedule,100% of APC rate,2071.67,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1159.2,40,,927.36,percent of total billed charges,40% of total billed charges,1080.08,2318.4,
OLANZAPINE 10MG TAB,6400014,CDM,250,RC,,,Outpatient,,,67.9,54.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.32,80,,43.46,percent of total billed charges,80% of total billed charges,25.31,37.27,,20.25,percent of total billed charges,37.27% of total billed charges,25.31,37.27,,20.25,percent of total billed charges,37.27% of total billed charges,25.31,37.27,,20.25,percent of total billed charges,37.27% 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,27.16,40,,21.73,percent of total billed charges,40% of total billed charges,25.31,54.32,
CITALOPRAM 10MG TAB,5880901,CDM,637,RC,,,Outpatient,,,8.25,6.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.6,80,,5.28,percent of total billed charges,80% of total billed charges,3.07,37.27,,2.46,percent of total billed charges,37.27% of total billed charges,3.07,37.27,,2.46,percent of total billed charges,37.27% of total billed charges,3.07,37.27,,2.46,percent of total billed charges,37.27% 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,3.3,40,,2.64,percent of total billed charges,40% of total billed charges,3.07,6.6,
PHENYLEPHRINE 10MGIV,6065130,CDM,636,RC,J2371,HCPCS,Outpatient,,,16.35,13.08,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13.08,80,,10.46,percent of total billed charges,80% of total billed charges,6.09,37.27,,4.87,percent of total billed charges,37.27% of total billed charges,6.09,37.27,,4.87,percent of total billed charges,37.27% of total billed charges,6.09,37.27,,4.87,percent of total billed charges,37.27% 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,6.54,40,,5.23,percent of total billed charges,40% of total billed charges,6.09,13.08,
KCL 10MEQ PREMIX IV,6065130,CDM,636,RC,J3480,HCPCS,Outpatient,,,0.1,0.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.08,80,,0.06,percent of total billed charges,80% of total billed charges,0.04,37.27,,0.03,percent of total billed charges,37.27% of total billed charges,0.04,37.27,,0.03,percent of total billed charges,37.27% of total billed charges,0.04,37.27,,0.03,percent of total billed charges,37.27% 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,0.04,40,,0.03,percent of total billed charges,40% of total billed charges,0.04,0.08,
MRI ELASTOGRAPHY,6212047,CDM,610,RC,76391,HCPCS,Outpatient,,,650,520.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520,80,,416,percent of total billed charges,80% of total billed charges,242.26,37.27,,193.81,percent of total billed charges,37.27% of total billed charges,242.26,37.27,,193.81,percent of total billed charges,37.27% of total billed charges,242.26,37.27,,193.81,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,196.87,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260,40,,208,percent of total billed charges,40% of total billed charges,196.87,520,
VERQUVO 2.5MG,6400014,CDM,250,RC,,,Outpatient,,,83.45,66.76,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,66.76,80,,53.41,percent of total billed charges,80% of total billed charges,31.1,37.27,,24.88,percent of total billed charges,37.27% of total billed charges,31.1,37.27,,24.88,percent of total billed charges,37.27% of total billed charges,31.1,37.27,,24.88,percent of total billed charges,37.27% 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,33.38,40,,26.7,percent of total billed charges,40% of total billed charges,31.1,66.76,
EVOLVE HEAD 496H022,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,7043,5634.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5634.4,80,,4507.52,percent of total billed charges,80% of total billed charges,2624.93,37.27,,2099.94,percent of total billed charges,37.27% of total billed charges,2624.93,37.27,,2099.94,percent of total billed charges,37.27% of total billed charges,2624.93,37.27,,2099.94,percent of total billed charges,37.27% 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,2817.2,40,,2253.76,percent of total billed charges,40% of total billed charges,2624.93,5634.4,
EVOLVE STEM 496S065,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,8371,6696.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6696.8,80,,5357.44,percent of total billed charges,80% of total billed charges,3119.87,37.27,,2495.9,percent of total billed charges,37.27% of total billed charges,3119.87,37.27,,2495.9,percent of total billed charges,37.27% of total billed charges,3119.87,37.27,,2495.9,percent of total billed charges,37.27% 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,3348.4,40,,2678.72,percent of total billed charges,40% of total billed charges,3119.87,6696.8,
TENDON ANT EVP801FF,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5988,4790.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4790.4,80,,3832.32,percent of total billed charges,80% of total billed charges,2231.73,37.27,,1785.38,percent of total billed charges,37.27% of total billed charges,2231.73,37.27,,1785.38,percent of total billed charges,37.27% of total billed charges,2231.73,37.27,,1785.38,percent of total billed charges,37.27% 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,2395.2,40,,1916.16,percent of total billed charges,40% of total billed charges,2231.73,4790.4,
EAR VENT MORET 14642,5645742,CDM,270,RC,,,Outpatient,,,187,149.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,149.6,80,,119.68,percent of total billed charges,80% of total billed charges,69.69,37.27,,55.75,percent of total billed charges,37.27% of total billed charges,69.69,37.27,,55.75,percent of total billed charges,37.27% of total billed charges,69.69,37.27,,55.75,percent of total billed charges,37.27% 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,74.8,40,,59.84,percent of total billed charges,40% of total billed charges,69.69,149.6,
TROPE AR1588RT2J,5645742,CDM,270,RC,,,Outpatient,,,1279,1023.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1023.2,80,,818.56,percent of total billed charges,80% of total billed charges,476.68,37.27,,381.34,percent of total billed charges,37.27% of total billed charges,476.68,37.27,,381.34,percent of total billed charges,37.27% of total billed charges,476.68,37.27,,381.34,percent of total billed charges,37.27% 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,511.6,40,,409.28,percent of total billed charges,40% of total billed charges,476.68,1023.2,
REAMER AR1410LP,5645742,CDM,270,RC,,,Outpatient,,,536,428.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428.8,80,,343.04,percent of total billed charges,80% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% 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,214.4,40,,171.52,percent of total billed charges,40% of total billed charges,199.77,428.8,
DRIVER AR1996CD1,5645742,CDM,270,RC,,,Outpatient,,,1375,1100.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1100,80,,880,percent of total billed charges,80% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% 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,550,40,,440,percent of total billed charges,40% of total billed charges,512.46,1100,
IMP SYS AR2600SBS9,8605396,CDM,278,RC,,,Outpatient,,,5253,4202.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4202.4,80,,3361.92,percent of total billed charges,80% of total billed charges,1957.79,37.27,,1566.23,percent of total billed charges,37.27% of total billed charges,1957.79,37.27,,1566.23,percent of total billed charges,37.27% of total billed charges,1957.79,37.27,,1566.23,percent of total billed charges,37.27% 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,2101.2,40,,1680.96,percent of total billed charges,40% of total billed charges,1957.79,4202.4,
SCREW AR4030C09,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,811,648.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,648.8,80,,519.04,percent of total billed charges,80% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% 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,324.4,40,,259.52,percent of total billed charges,40% of total billed charges,302.26,648.8,
KNEE LIGAMENT AR5511,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3286,2628.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2628.8,80,,2103.04,percent of total billed charges,80% of total billed charges,1224.69,37.27,,979.75,percent of total billed charges,37.27% of total billed charges,1224.69,37.27,,979.75,percent of total billed charges,37.27% of total billed charges,1224.69,37.27,,979.75,percent of total billed charges,37.27% 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,1314.4,40,,1051.52,percent of total billed charges,40% of total billed charges,1224.69,2628.8,
TRELEGY ELLIPTA,6400014,CDM,250,RC,A9270,HCPCS,Outpatient,,,959.95,767.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,767.96,80,,614.37,percent of total billed charges,80% of total billed charges,357.77,37.27,,286.22,percent of total billed charges,37.27% of total billed charges,357.77,37.27,,286.22,percent of total billed charges,37.27% of total billed charges,357.77,37.27,,286.22,percent of total billed charges,37.27% 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,383.98,40,,307.18,percent of total billed charges,40% of total billed charges,357.77,767.96,
GRAFT EVO PS290FF,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,9625,7700.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7700,80,,6160,percent of total billed charges,80% of total billed charges,3587.24,37.27,,2869.79,percent of total billed charges,37.27% of total billed charges,3587.24,37.27,,2869.79,percent of total billed charges,37.27% of total billed charges,3587.24,37.27,,2869.79,percent of total billed charges,37.27% 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,3850,40,,3080,percent of total billed charges,40% of total billed charges,3587.24,7700,
SCREW IC30028,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,625,500.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,500,80,,400,percent of total billed charges,80% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% 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,250,40,,200,percent of total billed charges,40% of total billed charges,232.94,500,
SCREW IC3040,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,625,500.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,500,80,,400,percent of total billed charges,80% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% 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,250,40,,200,percent of total billed charges,40% of total billed charges,232.94,500,
DRILL BIT IS1113,5801832,CDM,272,RC,,,Outpatient,,,1079,863.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,863.2,80,,690.56,percent of total billed charges,80% of total billed charges,402.14,37.27,,321.71,percent of total billed charges,37.27% of total billed charges,402.14,37.27,,321.71,percent of total billed charges,37.27% of total billed charges,402.14,37.27,,321.71,percent of total billed charges,37.27% 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,431.6,40,,345.28,percent of total billed charges,40% of total billed charges,402.14,863.2,
K WIRE KN1116,5801832,CDM,272,RC,,,Outpatient,,,134,107.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% 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,53.6,40,,42.88,percent of total billed charges,40% of total billed charges,49.94,107.2,
ROD 11197090,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,688,550.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,550.4,80,,440.32,percent of total billed charges,80% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% 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,275.2,40,,220.16,percent of total billed charges,40% of total billed charges,256.42,550.4,
ROD 11197100,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,688,550.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,550.4,80,,440.32,percent of total billed charges,80% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% 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,275.2,40,,220.16,percent of total billed charges,40% of total billed charges,256.42,550.4,
SCREW 51191632,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2200,1760.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1760,80,,1408,percent of total billed charges,80% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% 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,880,40,,704,percent of total billed charges,40% of total billed charges,819.94,1760,
SCREW 51191642,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2200,1760.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1760,80,,1408,percent of total billed charges,80% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% 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,880,40,,704,percent of total billed charges,40% of total billed charges,819.94,1760,
SCREW 51191647,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2200,1760.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1760,80,,1408,percent of total billed charges,80% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% 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,880,40,,704,percent of total billed charges,40% of total billed charges,819.94,1760,
SCREW 51191652,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2200,1760.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1760,80,,1408,percent of total billed charges,80% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% 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,880,40,,704,percent of total billed charges,40% of total billed charges,819.94,1760,
SCREW 51191737,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2200,1760.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1760,80,,1408,percent of total billed charges,80% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% of total billed charges,819.94,37.27,,655.95,percent of total billed charges,37.27% 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,880,40,,704,percent of total billed charges,40% of total billed charges,819.94,1760,
SPACER 11722010S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,17875,14300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14300,80,,11440,percent of total billed charges,80% of total billed charges,6662.01,37.27,,5329.61,percent of total billed charges,37.27% of total billed charges,6662.01,37.27,,5329.61,percent of total billed charges,37.27% of total billed charges,6662.01,37.27,,5329.61,percent of total billed charges,37.27% 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,7150,40,,5720,percent of total billed charges,40% of total billed charges,6662.01,14300,
VANCOMYCIN 1GM/NS200,6065130,CDM,636,RC,J3370,HCPCS,Outpatient,,,32.73,26.18,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.18,80,,20.94,percent of total billed charges,80% of total billed charges,12.2,37.27,,9.76,percent of total billed charges,37.27% of total billed charges,12.2,37.27,,9.76,percent of total billed charges,37.27% of total billed charges,12.2,37.27,,9.76,percent of total billed charges,37.27% 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,13.09,40,,10.47,percent of total billed charges,40% of total billed charges,12.2,26.18,
LIPIDS 20% 250ML,6065130,CDM,636,RC,,,Outpatient,,,192.8,154.24,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,154.24,80,,123.39,percent of total billed charges,80% of total billed charges,71.86,37.27,,57.49,percent of total billed charges,37.27% of total billed charges,71.86,37.27,,57.49,percent of total billed charges,37.27% of total billed charges,71.86,37.27,,57.49,percent of total billed charges,37.27% 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,77.12,40,,61.7,percent of total billed charges,40% of total billed charges,71.86,154.24,
CT LOWER EXT W/WO,6010052,CDM,350,RC,73702,HCPCS,Outpatient,,,2399,1919.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1919.2,80,,1535.36,percent of total billed charges,80% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,182.48,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,959.6,40,,767.68,percent of total billed charges,40% of total billed charges,151.49,1919.2,
CT UPPER EXT W/WO,6010052,CDM,350,RC,73202,HCPCS,Outpatient,,,2399,1919.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1919.2,80,,1535.36,percent of total billed charges,80% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,894.11,37.27,,715.29,percent of total billed charges,37.27% of total billed charges,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,252.26,145,,,fee schedule,145% of CMS fee schedule,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,151.49,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,959.6,40,,767.68,percent of total billed charges,40% of total billed charges,151.49,1919.2,
PLATE 629366PLATE 62,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3495,2796.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2796,80,,2236.8,percent of total billed charges,80% of total billed charges,1302.59,37.27,,1042.07,percent of total billed charges,37.27% of total billed charges,1302.59,37.27,,1042.07,percent of total billed charges,37.27% of total billed charges,1302.59,37.27,,1042.07,percent of total billed charges,37.27% 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,1398,40,,1118.4,percent of total billed charges,40% of total billed charges,1302.59,2796,
SCREW 657310,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,608,486.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,486.4,80,,389.12,percent of total billed charges,80% of total billed charges,226.6,37.27,,181.28,percent of total billed charges,37.27% of total billed charges,226.6,37.27,,181.28,percent of total billed charges,37.27% of total billed charges,226.6,37.27,,181.28,percent of total billed charges,37.27% 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,243.2,40,,194.56,percent of total billed charges,40% of total billed charges,226.6,486.4,
FEM STEM 155402150,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2131,1704.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1704.8,80,,1363.84,percent of total billed charges,80% of total billed charges,794.22,37.27,,635.38,percent of total billed charges,37.27% of total billed charges,794.22,37.27,,635.38,percent of total billed charges,37.27% of total billed charges,794.22,37.27,,635.38,percent of total billed charges,37.27% 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,852.4,40,,681.92,percent of total billed charges,40% of total billed charges,794.22,1704.8,
FEM HEAD 136536740,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,16049,12839.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12839.2,80,,10271.36,percent of total billed charges,80% of total billed charges,5981.46,37.27,,4785.17,percent of total billed charges,37.27% of total billed charges,5981.46,37.27,,4785.17,percent of total billed charges,37.27% of total billed charges,5981.46,37.27,,4785.17,percent of total billed charges,37.27% 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,6419.6,40,,5135.68,percent of total billed charges,40% of total billed charges,5981.46,12839.2,
LEFT AMA FROM ER,8830002,CDM,450,RC,99283,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,835.24,100,,,case rate ,pays based on per visit rate,835.24,100,,,fee schedule,100% of APC rate,835.24,100,,,fee schedule,100% of APC rate,600,145,,,fee schedule,145% of CMS fee schedule,835.24,100,,,fee schedule,100% of APC rate,835.24,100,,,fee schedule,100% of APC rate,835.24,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,600,835.24,
FIBERWARE AR7211,5801832,CDM,272,RC,,,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% 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,44,40,,35.2,percent of total billed charges,40% of total billed charges,41,88,
PLATE 161234,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
ROD 11197045,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,388,310.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,310.4,80,,248.32,percent of total billed charges,80% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% of total billed charges,144.61,37.27,,115.69,percent of total billed charges,37.27% 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,155.2,40,,124.16,percent of total billed charges,40% of total billed charges,144.61,310.4,
SPACER 11722110S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,17875,14300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14300,80,,11440,percent of total billed charges,80% of total billed charges,6662.01,37.27,,5329.61,percent of total billed charges,37.27% of total billed charges,6662.01,37.27,,5329.61,percent of total billed charges,37.27% of total billed charges,6662.01,37.27,,5329.61,percent of total billed charges,37.27% 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,7150,40,,5720,percent of total billed charges,40% of total billed charges,6662.01,14300,
ROD 111840,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,734,587.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,587.2,80,,469.76,percent of total billed charges,80% of total billed charges,273.56,37.27,,218.85,percent of total billed charges,37.27% of total billed charges,273.56,37.27,,218.85,percent of total billed charges,37.27% of total billed charges,273.56,37.27,,218.85,percent of total billed charges,37.27% 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,293.6,40,,234.88,percent of total billed charges,40% of total billed charges,273.56,587.2,
LOCKING CAP 11490001,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,437,349.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,349.6,80,,279.68,percent of total billed charges,80% of total billed charges,162.87,37.27,,130.3,percent of total billed charges,37.27% of total billed charges,162.87,37.27,,130.3,percent of total billed charges,37.27% of total billed charges,162.87,37.27,,130.3,percent of total billed charges,37.27% 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,174.8,40,,139.84,percent of total billed charges,40% of total billed charges,162.87,349.6,
SCREW 11493512,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2918,2334.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2334.4,80,,1867.52,percent of total billed charges,80% of total billed charges,1087.54,37.27,,870.03,percent of total billed charges,37.27% of total billed charges,1087.54,37.27,,870.03,percent of total billed charges,37.27% of total billed charges,1087.54,37.27,,870.03,percent of total billed charges,37.27% 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,1167.2,40,,933.76,percent of total billed charges,40% of total billed charges,1087.54,2334.4,
SCREW 11493514,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2918,2334.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2334.4,80,,1867.52,percent of total billed charges,80% of total billed charges,1087.54,37.27,,870.03,percent of total billed charges,37.27% of total billed charges,1087.54,37.27,,870.03,percent of total billed charges,37.27% of total billed charges,1087.54,37.27,,870.03,percent of total billed charges,37.27% 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,1167.2,40,,933.76,percent of total billed charges,40% of total billed charges,1087.54,2334.4,
IV INFUSION ENTYVIO,5811182,CDM,260,RC,96413,HCPCS,Outpatient,,,526,420.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.8,80,,336.64,percent of total billed charges,80% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,166.63,145,,,fee schedule,145% of CMS fee schedule,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,40,,168.32,percent of total billed charges,40% of total billed charges,166.63,420.8,
MACI MEMBRANE,6065130,CDM,636,RC,J7330,HCPCS,Outpatient,,,65000,52000.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,52000,80,,41600,percent of total billed charges,80% of total billed charges,24225.5,37.27,,19380.4,percent of total billed charges,37.27% of total billed charges,24225.5,37.27,,19380.4,percent of total billed charges,37.27% of total billed charges,24225.5,37.27,,19380.4,percent of total billed charges,37.27% 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,26000,40,,20800,percent of total billed charges,40% of total billed charges,24225.5,52000,
PLATE 52020400,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4565,3652.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3652,80,,2921.6,percent of total billed charges,80% of total billed charges,1701.38,37.27,,1361.1,percent of total billed charges,37.27% of total billed charges,1701.38,37.27,,1361.1,percent of total billed charges,37.27% of total billed charges,1701.38,37.27,,1361.1,percent of total billed charges,37.27% 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,1826,40,,1460.8,percent of total billed charges,40% of total billed charges,1701.38,3652,
SCREW 5201024014,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% 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,198,40,,158.4,percent of total billed charges,40% of total billed charges,184.49,396,
SCREW 5201024018,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% 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,198,40,,158.4,percent of total billed charges,40% of total billed charges,184.49,396,
DRILL BIT 52031330,5801832,CDM,272,RC,,,Outpatient,,,448,358.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,358.4,80,,286.72,percent of total billed charges,80% of total billed charges,166.97,37.27,,133.58,percent of total billed charges,37.27% of total billed charges,166.97,37.27,,133.58,percent of total billed charges,37.27% of total billed charges,166.97,37.27,,133.58,percent of total billed charges,37.27% 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,179.2,40,,143.36,percent of total billed charges,40% of total billed charges,166.97,358.4,
SCREW IC2514,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,625,500.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,500,80,,400,percent of total billed charges,80% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% 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,250,40,,200,percent of total billed charges,40% of total billed charges,232.94,500,
SCREW IH2512,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1089,871.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,871.2,80,,696.96,percent of total billed charges,80% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% 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,435.6,40,,348.48,percent of total billed charges,40% of total billed charges,405.87,871.2,
SCREW IH4036,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1089,871.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,871.2,80,,696.96,percent of total billed charges,80% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% 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,435.6,40,,348.48,percent of total billed charges,40% of total billed charges,405.87,871.2,
SCREW IH4040,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1089,871.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,871.2,80,,696.96,percent of total billed charges,80% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% 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,435.6,40,,348.48,percent of total billed charges,40% of total billed charges,405.87,871.2,
DRILL BIT IS1114,5801832,CDM,272,RC,,,Outpatient,,,1079,863.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,863.2,80,,690.56,percent of total billed charges,80% of total billed charges,402.14,37.27,,321.71,percent of total billed charges,37.27% of total billed charges,402.14,37.27,,321.71,percent of total billed charges,37.27% of total billed charges,402.14,37.27,,321.71,percent of total billed charges,37.27% 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,431.6,40,,345.28,percent of total billed charges,40% of total billed charges,402.14,863.2,
K WIRE KN1115,5801832,CDM,272,RC,,,Outpatient,,,134,107.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% 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,53.6,40,,42.88,percent of total billed charges,40% of total billed charges,49.94,107.2,
DIAMOX INJ 500MG,6065130,CDM,636,RC,J1120,HCPCS,Outpatient,,,162.45,129.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,129.96,80,,103.97,percent of total billed charges,80% of total billed charges,60.55,37.27,,48.44,percent of total billed charges,37.27% of total billed charges,60.55,37.27,,48.44,percent of total billed charges,37.27% of total billed charges,60.55,37.27,,48.44,percent of total billed charges,37.27% 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,64.98,40,,51.98,percent of total billed charges,40% of total billed charges,60.55,129.96,
CANC CHIPS 5CC,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,1188,950.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,950.4,80,,760.32,percent of total billed charges,80% of total billed charges,442.77,37.27,,354.22,percent of total billed charges,37.27% of total billed charges,442.77,37.27,,354.22,percent of total billed charges,37.27% of total billed charges,442.77,37.27,,354.22,percent of total billed charges,37.27% 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,475.2,40,,380.16,percent of total billed charges,40% of total billed charges,442.77,950.4,
BIZACT TONSIL DEV,5801832,CDM,272,RC,,,Outpatient,,,1219,975.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,975.2,80,,780.16,percent of total billed charges,80% of total billed charges,454.32,37.27,,363.46,percent of total billed charges,37.27% of total billed charges,454.32,37.27,,363.46,percent of total billed charges,37.27% of total billed charges,454.32,37.27,,363.46,percent of total billed charges,37.27% 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,487.6,40,,390.08,percent of total billed charges,40% of total billed charges,454.32,975.2,
ENTRESTO 49-51 TAB,5880901,CDM,637,RC,,,Outpatient,,,46.9,37.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,37.52,80,,30.02,percent of total billed charges,80% of total billed charges,17.48,37.27,,13.98,percent of total billed charges,37.27% of total billed charges,17.48,37.27,,13.98,percent of total billed charges,37.27% of total billed charges,17.48,37.27,,13.98,percent of total billed charges,37.27% 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,18.76,40,,15.01,percent of total billed charges,40% of total billed charges,17.48,37.52,
ABD ACUTE SERIES,6000392,CDM,320,RC,74022,HCPCS,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,44.52,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198,40,,158.4,percent of total billed charges,40% of total billed charges,44.52,396,
ALPHAVENT 3910947208,5801832,CDM,272,RC,,,Outpatient,,,413,330.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% 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,165.2,40,,132.16,percent of total billed charges,40% of total billed charges,153.93,330.4,
ALPHAVENT 3910947202,5801832,CDM,272,RC,,,Outpatient,,,413,330.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% 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,165.2,40,,132.16,percent of total billed charges,40% of total billed charges,153.93,330.4,
PEEK ANCH 3910500391,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1334,1067.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1067.2,80,,853.76,percent of total billed charges,80% of total billed charges,497.18,37.27,,397.74,percent of total billed charges,37.27% of total billed charges,497.18,37.27,,397.74,percent of total billed charges,37.27% of total billed charges,497.18,37.27,,397.74,percent of total billed charges,37.27% 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,533.6,40,,426.88,percent of total billed charges,40% of total billed charges,497.18,1067.2,
SUT ANCH 3910947120,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1372,1097.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1097.6,80,,878.08,percent of total billed charges,80% of total billed charges,511.34,37.27,,409.07,percent of total billed charges,37.27% of total billed charges,511.34,37.27,,409.07,percent of total billed charges,37.27% of total billed charges,511.34,37.27,,409.07,percent of total billed charges,37.27% 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,548.8,40,,439.04,percent of total billed charges,40% of total billed charges,511.34,1097.6,
US NON VAS EXT COMPL,6000566,CDM,402,RC,76881,HCPCS,Outpatient,,,325,260.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,260,80,,208,percent of total billed charges,80% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% of total billed charges,121.13,37.27,,96.9,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,14.08,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,130,40,,104,percent of total billed charges,40% of total billed charges,14.08,260,
PHOSPHARIDYLETHANOL,7000029,CDM,301,RC,80321,HCPCS,Outpatient,,,298,238.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,238.4,80,,190.72,percent of total billed charges,80% of total billed charges,111.06,37.27,,88.85,percent of total billed charges,37.27% of total billed charges,111.06,37.27,,88.85,percent of total billed charges,37.27% of total billed charges,111.06,37.27,,88.85,percent of total billed charges,37.27% 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,119.2,40,,95.36,percent of total billed charges,40% of total billed charges,111.06,238.4,
SCREW D2N30014,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,718,574.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,574.4,80,,459.52,percent of total billed charges,80% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% 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,287.2,40,,229.76,percent of total billed charges,40% of total billed charges,267.6,574.4,
K WIRE DSDS1009,5645742,CDM,270,RC,,,Outpatient,,,122,97.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% 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,48.8,40,,39.04,percent of total billed charges,40% of total billed charges,45.47,97.6,
ACET SHELL 121732060,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4463,3570.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3570.4,80,,2856.32,percent of total billed charges,80% of total billed charges,1663.36,37.27,,1330.69,percent of total billed charges,37.27% of total billed charges,1663.36,37.27,,1330.69,percent of total billed charges,37.27% of total billed charges,1663.36,37.27,,1330.69,percent of total billed charges,37.27% 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,1785.2,40,,1428.16,percent of total billed charges,40% of total billed charges,1663.36,3570.4,
SCREW 121730500,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
ACET LINER 122136160,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2272,1817.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1817.6,80,,1454.08,percent of total billed charges,80% of total billed charges,846.77,37.27,,677.42,percent of total billed charges,37.27% of total billed charges,846.77,37.27,,677.42,percent of total billed charges,37.27% of total billed charges,846.77,37.27,,677.42,percent of total billed charges,37.27% 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,908.8,40,,727.04,percent of total billed charges,40% of total billed charges,846.77,1817.6,
FEM STEM 157002150,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4881,3904.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3904.8,80,,3123.84,percent of total billed charges,80% of total billed charges,1819.15,37.27,,1455.32,percent of total billed charges,37.27% of total billed charges,1819.15,37.27,,1455.32,percent of total billed charges,37.27% of total billed charges,1819.15,37.27,,1455.32,percent of total billed charges,37.27% 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,1952.4,40,,1561.92,percent of total billed charges,40% of total billed charges,1819.15,3904.8,
OSS PICC STERILE TEC,5612346,CDM,761,RC,36569,HCPCS,Outpatient,,,2700,2160.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2160,80,,1728,percent of total billed charges,80% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,133.08,145,,,fee schedule,145% of CMS fee schedule,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1080,40,,864,percent of total billed charges,40% of total billed charges,133.08,2160,
SCREW AR8724VCL16,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,811,648.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,648.8,80,,519.04,percent of total billed charges,80% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% 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,324.4,40,,259.52,percent of total billed charges,40% of total billed charges,302.26,648.8,
SCREW AR8724VCL18,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,811,648.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,648.8,80,,519.04,percent of total billed charges,80% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% 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,324.4,40,,259.52,percent of total billed charges,40% of total billed charges,302.26,648.8,
SCREW AR8724VCL20,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,811,648.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,648.8,80,,519.04,percent of total billed charges,80% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% of total billed charges,302.26,37.27,,241.81,percent of total billed charges,37.27% 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,324.4,40,,259.52,percent of total billed charges,40% of total billed charges,302.26,648.8,
SCREW AR873512,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,165,132.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% 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,66,40,,52.8,percent of total billed charges,40% of total billed charges,61.5,132,
SCREW AR873513,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,165,132.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,132,80,,105.6,percent of total billed charges,80% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% of total billed charges,61.5,37.27,,49.2,percent of total billed charges,37.27% 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,66,40,,52.8,percent of total billed charges,40% of total billed charges,61.5,132,
PLATE AR8916VNL03,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2186,1748.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1748.8,80,,1399.04,percent of total billed charges,80% of total billed charges,814.72,37.27,,651.78,percent of total billed charges,37.27% of total billed charges,814.72,37.27,,651.78,percent of total billed charges,37.27% of total billed charges,814.72,37.27,,651.78,percent of total billed charges,37.27% 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,874.4,40,,699.52,percent of total billed charges,40% of total billed charges,814.72,1748.8,
FAC CHG 99213 EST PT,5612353,CDM,510,RC,99213,HCPCS,Outpatient,,,131,104.80,  ,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,104.8,80,,83.84,percent of total billed charges,80% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% of total billed charges,48.82,37.27,,39.06,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,91.94,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,48.82,104.8,
FAC CHG 99214 EST PT,5612353,CDM,510,RC,99214,HCPCS,Outpatient,,,194,155.20,  ,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,155.2,80,,124.16,percent of total billed charges,80% of total billed charges,72.3,37.27,,57.84,percent of total billed charges,37.27% of total billed charges,72.3,37.27,,57.84,percent of total billed charges,37.27% of total billed charges,72.3,37.27,,57.84,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,135.49,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,72.3,155.2,
FAC CHG 99215 EST PT,5612353,CDM,510,RC,99215,HCPCS,Outpatient,,,254,203.20,  ,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,203.2,80,,162.56,percent of total billed charges,80% of total billed charges,94.67,37.27,,75.74,percent of total billed charges,37.27% of total billed charges,94.67,37.27,,75.74,percent of total billed charges,37.27% of total billed charges,94.67,37.27,,75.74,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,200.98,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,94.67,203.2,
K WIRE 702459S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,285,228.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,228,80,,182.4,percent of total billed charges,80% of total billed charges,106.22,37.27,,84.98,percent of total billed charges,37.27% of total billed charges,106.22,37.27,,84.98,percent of total billed charges,37.27% of total billed charges,106.22,37.27,,84.98,percent of total billed charges,37.27% 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,114,40,,91.2,percent of total billed charges,40% of total billed charges,106.22,228,
PLATE 626674,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1028,822.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,822.4,80,,657.92,percent of total billed charges,80% of total billed charges,383.14,37.27,,306.51,percent of total billed charges,37.27% of total billed charges,383.14,37.27,,306.51,percent of total billed charges,37.27% of total billed charges,383.14,37.27,,306.51,percent of total billed charges,37.27% 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,411.2,40,,328.96,percent of total billed charges,40% of total billed charges,383.14,822.4,
SCREW 657436,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,331,264.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,264.8,80,,211.84,percent of total billed charges,80% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% of total billed charges,123.36,37.27,,98.69,percent of total billed charges,37.27% 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,132.4,40,,105.92,percent of total billed charges,40% of total billed charges,123.36,264.8,
CEFAZOLIN 2GM,6065130,CDM,636,RC,J0690,HCPCS,Outpatient,,,9.74,7.79,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7.79,80,,6.23,percent of total billed charges,80% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% of total billed charges,3.63,37.27,,2.9,percent of total billed charges,37.27% 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,3.9,40,,3.12,percent of total billed charges,40% of total billed charges,3.63,7.79,
DISSECTOR SONICISION,5645742,CDM,270,RC,,,Outpatient,,,2774,2219.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2219.2,80,,1775.36,percent of total billed charges,80% of total billed charges,1033.87,37.27,,827.1,percent of total billed charges,37.27% of total billed charges,1033.87,37.27,,827.1,percent of total billed charges,37.27% of total billed charges,1033.87,37.27,,827.1,percent of total billed charges,37.27% 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,1109.6,40,,887.68,percent of total billed charges,40% of total billed charges,1033.87,2219.2,
LASSO AR606845L,5645742,CDM,270,RC,,,Outpatient,,,481,384.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384.8,80,,307.84,percent of total billed charges,80% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% 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,192.4,40,,153.92,percent of total billed charges,40% of total billed charges,179.27,384.8,
LASSO AR6068C,5645742,CDM,270,RC,,,Outpatient,,,990,792.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,792,80,,633.6,percent of total billed charges,80% of total billed charges,368.97,37.27,,295.18,percent of total billed charges,37.27% of total billed charges,368.97,37.27,,295.18,percent of total billed charges,37.27% of total billed charges,368.97,37.27,,295.18,percent of total billed charges,37.27% 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,396,40,,316.8,percent of total billed charges,40% of total billed charges,368.97,792,
FIBERWIRE AR7209,5801832,CDM,272,RC,,,Outpatient,,,454,363.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,169.21,37.27,,135.37,percent of total billed charges,37.27% of total billed charges,169.21,37.27,,135.37,percent of total billed charges,37.27% of total billed charges,169.21,37.27,,135.37,percent of total billed charges,37.27% 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,181.6,40,,145.28,percent of total billed charges,40% of total billed charges,169.21,363.2,
SCREW 184154,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1169,935.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,935.2,80,,748.16,percent of total billed charges,80% of total billed charges,435.69,37.27,,348.55,percent of total billed charges,37.27% of total billed charges,435.69,37.27,,348.55,percent of total billed charges,37.27% of total billed charges,435.69,37.27,,348.55,percent of total billed charges,37.27% 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,467.6,40,,374.08,percent of total billed charges,40% of total billed charges,435.69,935.2,
SPACER 31362106,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,6875,5500.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5500,80,,4400,percent of total billed charges,80% of total billed charges,2562.31,37.27,,2049.85,percent of total billed charges,37.27% of total billed charges,2562.31,37.27,,2049.85,percent of total billed charges,37.27% of total billed charges,2562.31,37.27,,2049.85,percent of total billed charges,37.27% 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,2750,40,,2200,percent of total billed charges,40% of total billed charges,2562.31,5500,
PUSHLOCK AR1923DHS,5801832,CDM,272,RC,C1713,HCPCS,Outpatient,,,481,384.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384.8,80,,307.84,percent of total billed charges,80% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% 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,192.4,40,,153.92,percent of total billed charges,40% of total billed charges,179.27,384.8,
SUT ANCHOR AR1923PHS,5801832,CDM,272,RC,C1713,HCPCS,Outpatient,,,990,792.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,792,80,,633.6,percent of total billed charges,80% of total billed charges,368.97,37.27,,295.18,percent of total billed charges,37.27% of total billed charges,368.97,37.27,,295.18,percent of total billed charges,37.27% of total billed charges,368.97,37.27,,295.18,percent of total billed charges,37.27% 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,396,40,,316.8,percent of total billed charges,40% of total billed charges,368.97,792,
SUL LASSO AR406845RH,5801832,CDM,272,RC,,,Outpatient,,,454,363.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,363.2,80,,290.56,percent of total billed charges,80% of total billed charges,169.21,37.27,,135.37,percent of total billed charges,37.27% of total billed charges,169.21,37.27,,135.37,percent of total billed charges,37.27% of total billed charges,169.21,37.27,,135.37,percent of total billed charges,37.27% 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,181.6,40,,145.28,percent of total billed charges,40% of total billed charges,169.21,363.2,
DISSECTOR AR6420CDS,5645742,CDM,270,RC,,,Outpatient,,,212,169.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,169.6,80,,135.68,percent of total billed charges,80% of total billed charges,79.01,37.27,,63.21,percent of total billed charges,37.27% of total billed charges,79.01,37.27,,63.21,percent of total billed charges,37.27% of total billed charges,79.01,37.27,,63.21,percent of total billed charges,37.27% 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,84.8,40,,67.84,percent of total billed charges,40% of total billed charges,79.01,169.6,
ARTHRO KIT AR6527S,5645742,CDM,270,RC,,,Outpatient,,,1031,824.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,824.8,80,,659.84,percent of total billed charges,80% of total billed charges,384.25,37.27,,307.4,percent of total billed charges,37.27% of total billed charges,384.25,37.27,,307.4,percent of total billed charges,37.27% of total billed charges,384.25,37.27,,307.4,percent of total billed charges,37.27% 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,412.4,40,,329.92,percent of total billed charges,40% of total billed charges,384.25,824.8,
HDS PAD KIT AR652911,5801832,CDM,272,RC,,,Outpatient,,,687,549.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,549.6,80,,439.68,percent of total billed charges,80% of total billed charges,256.04,37.27,,204.83,percent of total billed charges,37.27% of total billed charges,256.04,37.27,,204.83,percent of total billed charges,37.27% of total billed charges,256.04,37.27,,204.83,percent of total billed charges,37.27% 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,274.8,40,,219.84,percent of total billed charges,40% of total billed charges,256.04,549.6,
ARTHRO SET AR6517S,5801832,CDM,272,RC,,,Outpatient,,,1237,989.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,989.6,80,,791.68,percent of total billed charges,80% of total billed charges,461.03,37.27,,368.82,percent of total billed charges,37.27% of total billed charges,461.03,37.27,,368.82,percent of total billed charges,37.27% of total billed charges,461.03,37.27,,368.82,percent of total billed charges,37.27% 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,494.8,40,,395.84,percent of total billed charges,40% of total billed charges,461.03,989.6,
ARTHRO INST AR6575S,5801832,CDM,272,RC,,,Outpatient,,,962,769.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,769.6,80,,615.68,percent of total billed charges,80% of total billed charges,358.54,37.27,,286.83,percent of total billed charges,37.27% of total billed charges,358.54,37.27,,286.83,percent of total billed charges,37.27% of total billed charges,358.54,37.27,,286.83,percent of total billed charges,37.27% 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,384.8,40,,307.84,percent of total billed charges,40% of total billed charges,358.54,769.6,
SCOPE RENTAL AR6576S,5645742,CDM,270,RC,,,Outpatient,,,1100,880.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,880,80,,704,percent of total billed charges,80% of total billed charges,409.97,37.27,,327.98,percent of total billed charges,37.27% of total billed charges,409.97,37.27,,327.98,percent of total billed charges,37.27% of total billed charges,409.97,37.27,,327.98,percent of total billed charges,37.27% 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,440,40,,352,percent of total billed charges,40% of total billed charges,409.97,880,
SCREW IH4050,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1089,871.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,871.2,80,,696.96,percent of total billed charges,80% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% 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,435.6,40,,348.48,percent of total billed charges,40% of total billed charges,405.87,871.2,
SCREW IG3034,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1089,871.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,871.2,80,,696.96,percent of total billed charges,80% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% 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,435.6,40,,348.48,percent of total billed charges,40% of total billed charges,405.87,871.2,
K WIRE KN1117,5801832,CDM,272,RC,C1713,HCPCS,Outpatient,,,134,107.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,107.2,80,,85.76,percent of total billed charges,80% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% of total billed charges,49.94,37.27,,39.95,percent of total billed charges,37.27% 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,53.6,40,,42.88,percent of total billed charges,40% of total billed charges,49.94,107.2,
FENTANYL 50MCG/ML1ML,6065130,CDM,636,RC,J3010,HCPCS,Outpatient,,,0.1,0.08,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.08,80,,0.06,percent of total billed charges,80% of total billed charges,0.04,37.27,,0.03,percent of total billed charges,37.27% of total billed charges,0.04,37.27,,0.03,percent of total billed charges,37.27% of total billed charges,0.04,37.27,,0.03,percent of total billed charges,37.27% 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,0.04,40,,0.03,percent of total billed charges,40% of total billed charges,0.04,0.08,
PRECEDEX 200MCG,6065130,CDM,636,RC,J8499,HCPCS,Outpatient,,,22.15,17.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,17.72,80,,14.18,percent of total billed charges,80% of total billed charges,8.26,37.27,,6.61,percent of total billed charges,37.27% of total billed charges,8.26,37.27,,6.61,percent of total billed charges,37.27% of total billed charges,8.26,37.27,,6.61,percent of total billed charges,37.27% 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,8.86,40,,7.09,percent of total billed charges,40% of total billed charges,8.26,17.72,
FEM HEAD 5510F402,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4950,3960.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3960,80,,3168,percent of total billed charges,80% of total billed charges,1844.87,37.27,,1475.9,percent of total billed charges,37.27% of total billed charges,1844.87,37.27,,1475.9,percent of total billed charges,37.27% of total billed charges,1844.87,37.27,,1475.9,percent of total billed charges,37.27% 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,1980,40,,1584,percent of total billed charges,40% of total billed charges,1844.87,3960,
TIB BASE 5520B400,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4615,3692.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3692,80,,2953.6,percent of total billed charges,80% of total billed charges,1720.01,37.27,,1376.01,percent of total billed charges,37.27% of total billed charges,1720.01,37.27,,1376.01,percent of total billed charges,37.27% of total billed charges,1720.01,37.27,,1376.01,percent of total billed charges,37.27% 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,1846,40,,1476.8,percent of total billed charges,40% of total billed charges,1720.01,3692,
TIB BEAR 5531G410E,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
PLATE 628026,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3474,2779.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2779.2,80,,2223.36,percent of total billed charges,80% of total billed charges,1294.76,37.27,,1035.81,percent of total billed charges,37.27% of total billed charges,1294.76,37.27,,1035.81,percent of total billed charges,37.27% of total billed charges,1294.76,37.27,,1035.81,percent of total billed charges,37.27% 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,1389.6,40,,1111.68,percent of total billed charges,40% of total billed charges,1294.76,2779.2,
SUT ANCH AR1662BC,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1125,900.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,900,80,,720,percent of total billed charges,80% of total billed charges,419.29,37.27,,335.43,percent of total billed charges,37.27% of total billed charges,419.29,37.27,,335.43,percent of total billed charges,37.27% of total billed charges,419.29,37.27,,335.43,percent of total billed charges,37.27% 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,450,40,,360,percent of total billed charges,40% of total billed charges,419.29,900,
SWIVELOCK AR2324BCC2,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1147,917.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,917.6,80,,734.08,percent of total billed charges,80% of total billed charges,427.49,37.27,,341.99,percent of total billed charges,37.27% of total billed charges,427.49,37.27,,341.99,percent of total billed charges,37.27% of total billed charges,427.49,37.27,,341.99,percent of total billed charges,37.27% 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,458.8,40,,367.04,percent of total billed charges,40% of total billed charges,427.49,917.6,
SWIVELOCK AR2600SBS8,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5253,4202.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4202.4,80,,3361.92,percent of total billed charges,80% of total billed charges,1957.79,37.27,,1566.23,percent of total billed charges,37.27% of total billed charges,1957.79,37.27,,1566.23,percent of total billed charges,37.27% of total billed charges,1957.79,37.27,,1566.23,percent of total billed charges,37.27% 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,2101.2,40,,1680.96,percent of total billed charges,40% of total billed charges,1957.79,4202.4,
KNIFE AR228509,5801832,CDM,272,RC,,,Outpatient,,,129,103.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,103.2,80,,82.56,percent of total billed charges,80% of total billed charges,48.08,37.27,,38.46,percent of total billed charges,37.27% of total billed charges,48.08,37.27,,38.46,percent of total billed charges,37.27% of total billed charges,48.08,37.27,,38.46,percent of total billed charges,37.27% 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,51.6,40,,41.28,percent of total billed charges,40% of total billed charges,48.08,103.2,
PLATE 02112138,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3652,2921.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2921.6,80,,2337.28,percent of total billed charges,80% of total billed charges,1361.1,37.27,,1088.88,percent of total billed charges,37.27% of total billed charges,1361.1,37.27,,1088.88,percent of total billed charges,37.27% of total billed charges,1361.1,37.27,,1088.88,percent of total billed charges,37.27% 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,1460.8,40,,1168.64,percent of total billed charges,40% of total billed charges,1361.1,2921.6,
SCREW 202214,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,743,594.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,594.4,80,,475.52,percent of total billed charges,80% of total billed charges,276.92,37.27,,221.54,percent of total billed charges,37.27% of total billed charges,276.92,37.27,,221.54,percent of total billed charges,37.27% of total billed charges,276.92,37.27,,221.54,percent of total billed charges,37.27% 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,297.2,40,,237.76,percent of total billed charges,40% of total billed charges,276.92,594.4,
SCREW 202218,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,743,594.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,594.4,80,,475.52,percent of total billed charges,80% of total billed charges,276.92,37.27,,221.54,percent of total billed charges,37.27% of total billed charges,276.92,37.27,,221.54,percent of total billed charges,37.27% of total billed charges,276.92,37.27,,221.54,percent of total billed charges,37.27% 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,297.2,40,,237.76,percent of total billed charges,40% of total billed charges,276.92,594.4,
SCREW 202216,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,743,594.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,594.4,80,,475.52,percent of total billed charges,80% of total billed charges,276.92,37.27,,221.54,percent of total billed charges,37.27% of total billed charges,276.92,37.27,,221.54,percent of total billed charges,37.27% of total billed charges,276.92,37.27,,221.54,percent of total billed charges,37.27% 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,297.2,40,,237.76,percent of total billed charges,40% of total billed charges,276.92,594.4,
SCREW 212101,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,853,682.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,682.4,80,,545.92,percent of total billed charges,80% of total billed charges,317.91,37.27,,254.33,percent of total billed charges,37.27% of total billed charges,317.91,37.27,,254.33,percent of total billed charges,37.27% of total billed charges,317.91,37.27,,254.33,percent of total billed charges,37.27% 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,341.2,40,,272.96,percent of total billed charges,40% of total billed charges,317.91,682.4,
SCREW 212102,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,853,682.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,682.4,80,,545.92,percent of total billed charges,80% of total billed charges,317.91,37.27,,254.33,percent of total billed charges,37.27% of total billed charges,317.91,37.27,,254.33,percent of total billed charges,37.27% of total billed charges,317.91,37.27,,254.33,percent of total billed charges,37.27% 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,341.2,40,,272.96,percent of total billed charges,40% of total billed charges,317.91,682.4,
SCREW 202212,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,743,594.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,594.4,80,,475.52,percent of total billed charges,80% of total billed charges,276.92,37.27,,221.54,percent of total billed charges,37.27% of total billed charges,276.92,37.27,,221.54,percent of total billed charges,37.27% of total billed charges,276.92,37.27,,221.54,percent of total billed charges,37.27% 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,297.2,40,,237.76,percent of total billed charges,40% of total billed charges,276.92,594.4,
SCREW 207646,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1207,965.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,965.6,80,,772.48,percent of total billed charges,80% of total billed charges,449.85,37.27,,359.88,percent of total billed charges,37.27% of total billed charges,449.85,37.27,,359.88,percent of total billed charges,37.27% of total billed charges,449.85,37.27,,359.88,percent of total billed charges,37.27% 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,482.8,40,,386.24,percent of total billed charges,40% of total billed charges,449.85,965.6,
DRILL BIT 03133106,5801832,CDM,272,RC,,,Outpatient,,,767,613.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,613.6,80,,490.88,percent of total billed charges,80% of total billed charges,285.86,37.27,,228.69,percent of total billed charges,37.27% of total billed charges,285.86,37.27,,228.69,percent of total billed charges,37.27% of total billed charges,285.86,37.27,,228.69,percent of total billed charges,37.27% 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,306.8,40,,245.44,percent of total billed charges,40% of total billed charges,285.86,613.6,
K WIRE 900721,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,179,143.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% 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,71.6,40,,57.28,percent of total billed charges,40% of total billed charges,66.71,143.2,
ROD 71196200,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,688,550.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,550.4,80,,440.32,percent of total billed charges,80% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% of total billed charges,256.42,37.27,,205.14,percent of total billed charges,37.27% 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,275.2,40,,220.16,percent of total billed charges,40% of total billed charges,256.42,550.4,
SPACER 12114616S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5929,4743.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4743.2,80,,3794.56,percent of total billed charges,80% of total billed charges,2209.74,37.27,,1767.79,percent of total billed charges,37.27% of total billed charges,2209.74,37.27,,1767.79,percent of total billed charges,37.27% of total billed charges,2209.74,37.27,,1767.79,percent of total billed charges,37.27% 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,2371.6,40,,1897.28,percent of total billed charges,40% of total billed charges,2209.74,4743.2,
SCOLIOSIS SERIES 4-5,6000392,CDM,320,RC,72083,HCPCS,Outpatient,,,425,340.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,340,80,,272,percent of total billed charges,80% of total billed charges,158.4,37.27,,126.72,percent of total billed charges,37.27% of total billed charges,158.4,37.27,,126.72,percent of total billed charges,37.27% of total billed charges,158.4,37.27,,126.72,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,79.18,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,170,40,,136,percent of total billed charges,40% of total billed charges,79.18,340,
TIB BEAR 5531G412E,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
TENDON TIBIA PS841FF,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,6188,4950.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4950.4,80,,3960.32,percent of total billed charges,80% of total billed charges,2306.27,37.27,,1845.02,percent of total billed charges,37.27% of total billed charges,2306.27,37.27,,1845.02,percent of total billed charges,37.27% of total billed charges,2306.27,37.27,,1845.02,percent of total billed charges,37.27% 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,2475.2,40,,1980.16,percent of total billed charges,40% of total billed charges,2306.27,4950.4,
MAGIC MOUTHWASH,5880901,CDM,637,RC,,,Outpatient,,,391.45,313.16,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,313.16,80,,250.53,percent of total billed charges,80% of total billed charges,145.89,37.27,,116.71,percent of total billed charges,37.27% of total billed charges,145.89,37.27,,116.71,percent of total billed charges,37.27% of total billed charges,145.89,37.27,,116.71,percent of total billed charges,37.27% 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,156.58,40,,125.26,percent of total billed charges,40% of total billed charges,145.89,313.16,
SCREW IH4034,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1089,871.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,871.2,80,,696.96,percent of total billed charges,80% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% 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,435.6,40,,348.48,percent of total billed charges,40% of total billed charges,405.87,871.2,
SCREW 204822,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,206,164.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,164.8,80,,131.84,percent of total billed charges,80% of total billed charges,76.78,37.27,,61.42,percent of total billed charges,37.27% of total billed charges,76.78,37.27,,61.42,percent of total billed charges,37.27% of total billed charges,76.78,37.27,,61.42,percent of total billed charges,37.27% 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,82.4,40,,65.92,percent of total billed charges,40% of total billed charges,76.78,164.8,
TRI FEM 5517F402,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,6600,5280.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5280,80,,4224,percent of total billed charges,80% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% 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,2640,40,,2112,percent of total billed charges,40% of total billed charges,2459.82,5280,
TIB BEAR 5531F409E,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
KNOT PUSHER AR5845,5801832,CDM,272,RC,C1713,HCPCS,Outpatient,,,605,484.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,484,80,,387.2,percent of total billed charges,80% of total billed charges,225.48,37.27,,180.38,percent of total billed charges,37.27% of total billed charges,225.48,37.27,,180.38,percent of total billed charges,37.27% of total billed charges,225.48,37.27,,180.38,percent of total billed charges,37.27% 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,242,40,,193.6,percent of total billed charges,40% of total billed charges,225.48,484,
SPACER 12114617S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5929,4743.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4743.2,80,,3794.56,percent of total billed charges,80% of total billed charges,2209.74,37.27,,1767.79,percent of total billed charges,37.27% of total billed charges,2209.74,37.27,,1767.79,percent of total billed charges,37.27% of total billed charges,2209.74,37.27,,1767.79,percent of total billed charges,37.27% 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,2371.6,40,,1897.28,percent of total billed charges,40% of total billed charges,2209.74,4743.2,
"ZINPLAVA 1,000MG IV",6065130,CDM,636,RC,J0565,HCPCS,Outpatient,,,4560,3648.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3648,80,,2918.4,percent of total billed charges,80% of total billed charges,1699.51,37.27,,1359.61,percent of total billed charges,37.27% of total billed charges,1699.51,37.27,,1359.61,percent of total billed charges,37.27% of total billed charges,1699.51,37.27,,1359.61,percent of total billed charges,37.27% of total billed charges,39.86,100,,,fee schedule,100% of APC rate,39.86,100,,,fee schedule,100% of APC rate,39.86,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,39.86,100,,,fee schedule,100% of APC rate,39.86,100,,,fee schedule,100% of APC rate,39.86,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1824,40,,1459.2,percent of total billed charges,40% of total billed charges,39.86,3648,
SCREW AR4030C10,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
SCREW AR4030C11,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
TEGRETOL XR 100MG,6400014,CDM,250,RC,,,Outpatient,,,4.15,3.32,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3.32,80,,2.66,percent of total billed charges,80% of total billed charges,1.55,37.27,,1.24,percent of total billed charges,37.27% of total billed charges,1.55,37.27,,1.24,percent of total billed charges,37.27% of total billed charges,1.55,37.27,,1.24,percent of total billed charges,37.27% 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,1.66,40,,1.33,percent of total billed charges,40% of total billed charges,1.55,3.32,
ICU MIDLINE INSERTIO,5612346,CDM,761,RC,36410,HCPCS,Outpatient,,,2400,1920.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1920,80,,1536,percent of total billed charges,80% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.75,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,40,,768,percent of total billed charges,40% of total billed charges,12.75,1920,
MED/SURG MIDLINE INS,8400010,CDM,760,RC,36410,HCPCS,Outpatient,,,2400,1920.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1920,80,,1536,percent of total billed charges,80% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.75,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,40,,768,percent of total billed charges,40% of total billed charges,12.75,1920,
ER MIDLINE INSERTION,8830002,CDM,450,RC,36410,HCPCS,Outpatient,,,2400,1920.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1920,80,,1536,percent of total billed charges,80% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.75,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,40,,768,percent of total billed charges,40% of total billed charges,12.75,1920,
PIN 50268120,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,583,466.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,466.4,80,,373.12,percent of total billed charges,80% of total billed charges,217.28,37.27,,173.82,percent of total billed charges,37.27% of total billed charges,217.28,37.27,,173.82,percent of total billed charges,37.27% of total billed charges,217.28,37.27,,173.82,percent of total billed charges,37.27% 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,233.2,40,,186.56,percent of total billed charges,40% of total billed charges,217.28,466.4,
PIN 50504300,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,515,412.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,412,80,,329.6,percent of total billed charges,80% of total billed charges,191.94,37.27,,153.55,percent of total billed charges,37.27% of total billed charges,191.94,37.27,,153.55,percent of total billed charges,37.27% of total billed charges,191.94,37.27,,153.55,percent of total billed charges,37.27% 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,206,40,,164.8,percent of total billed charges,40% of total billed charges,191.94,412,
PIN 50185150,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,555,444.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,444,80,,355.2,percent of total billed charges,80% of total billed charges,206.85,37.27,,165.48,percent of total billed charges,37.27% of total billed charges,206.85,37.27,,165.48,percent of total billed charges,37.27% of total billed charges,206.85,37.27,,165.48,percent of total billed charges,37.27% 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,222,40,,177.6,percent of total billed charges,40% of total billed charges,206.85,444,
BAR 49227220,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1654,1323.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1323.2,80,,1058.56,percent of total billed charges,80% of total billed charges,616.45,37.27,,493.16,percent of total billed charges,37.27% of total billed charges,616.45,37.27,,493.16,percent of total billed charges,37.27% of total billed charges,616.45,37.27,,493.16,percent of total billed charges,37.27% 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,661.6,40,,529.28,percent of total billed charges,40% of total billed charges,616.45,1323.2,
ROD 49228200,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1367,1093.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1093.6,80,,874.88,percent of total billed charges,80% of total billed charges,509.48,37.27,,407.58,percent of total billed charges,37.27% of total billed charges,509.48,37.27,,407.58,percent of total billed charges,37.27% of total billed charges,509.48,37.27,,407.58,percent of total billed charges,37.27% 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,546.8,40,,437.44,percent of total billed charges,40% of total billed charges,509.48,1093.6,
ROD 49228350,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1300,1040.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1040,80,,832,percent of total billed charges,80% of total billed charges,484.51,37.27,,387.61,percent of total billed charges,37.27% of total billed charges,484.51,37.27,,387.61,percent of total billed charges,37.27% of total billed charges,484.51,37.27,,387.61,percent of total billed charges,37.27% 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,520,40,,416,percent of total billed charges,40% of total billed charges,484.51,1040,
ROD 49228400,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1490,1192.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1192,80,,953.6,percent of total billed charges,80% of total billed charges,555.32,37.27,,444.26,percent of total billed charges,37.27% of total billed charges,555.32,37.27,,444.26,percent of total billed charges,37.27% of total billed charges,555.32,37.27,,444.26,percent of total billed charges,37.27% 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,596,40,,476.8,percent of total billed charges,40% of total billed charges,555.32,1192,
CLAMP 49221020,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2281,1824.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1824.8,80,,1459.84,percent of total billed charges,80% of total billed charges,850.13,37.27,,680.1,percent of total billed charges,37.27% of total billed charges,850.13,37.27,,680.1,percent of total billed charges,37.27% of total billed charges,850.13,37.27,,680.1,percent of total billed charges,37.27% 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,912.4,40,,729.92,percent of total billed charges,40% of total billed charges,850.13,1824.8,
CLAMP 49221010,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2491,1992.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1992.8,80,,1594.24,percent of total billed charges,80% of total billed charges,928.4,37.27,,742.72,percent of total billed charges,37.27% of total billed charges,928.4,37.27,,742.72,percent of total billed charges,37.27% of total billed charges,928.4,37.27,,742.72,percent of total billed charges,37.27% 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,996.4,40,,797.12,percent of total billed charges,40% of total billed charges,928.4,1992.8,
CLAMP 49212060,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3110,2488.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2488,80,,1990.4,percent of total billed charges,80% of total billed charges,1159.1,37.27,,927.28,percent of total billed charges,37.27% of total billed charges,1159.1,37.27,,927.28,percent of total billed charges,37.27% of total billed charges,1159.1,37.27,,927.28,percent of total billed charges,37.27% 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,1244,40,,995.2,percent of total billed charges,40% of total billed charges,1159.1,2488,
POST 49222120,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,547,437.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,437.6,80,,350.08,percent of total billed charges,80% of total billed charges,203.87,37.27,,163.1,percent of total billed charges,37.27% of total billed charges,203.87,37.27,,163.1,percent of total billed charges,37.27% of total billed charges,203.87,37.27,,163.1,percent of total billed charges,37.27% 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,218.8,40,,175.04,percent of total billed charges,40% of total billed charges,203.87,437.6,
CT ANGIO AORTO-ILIO,6010052,CDM,350,RC,75635,HCPCS,Outpatient,,,2400,1920.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1920,80,,1536,percent of total billed charges,80% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,151.48,100,,,fee schedule,100% of APC rate,151.48,100,,,fee schedule,100% of APC rate,151.48,100,,,fee schedule,100% of APC rate,394.7,145,,,fee schedule,145% of CMS fee schedule,151.48,100,,,fee schedule,100% of APC rate,151.48,100,,,fee schedule,100% of APC rate,151.48,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,40,,768,percent of total billed charges,40% of total billed charges,151.48,1920,
MEDICARE FACILITY,5612353,CDM,510,RC,G0463,HCPCS,Outpatient,,,125.95,100.76,,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit,96.04,100,,,case rate ,pays based on per visit rate,96.04,100,,,case rate,pays based on per visit rate,100.76,80,,80.61,percent of total billed charges,80% of total billed charges,46.94,37.27,,37.55,percent of total billed charges,37.27% of total billed charges,46.94,37.27,,37.55,percent of total billed charges,37.27% of total billed charges,46.94,37.27,,37.55,percent of total billed charges,37.27% of total billed charges,108.99,100,,,fee schedule,100% of APC rate,108.99,100,,,fee schedule,100% of APC rate,108.99,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,108.99,100,,,fee schedule,100% of APC rate,108.99,100,,,fee schedule,100% of APC rate,108.99,100,,,fee schedule,100% of APC rate,96.04,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,96.04,100,,,case rate,pays based on per visit rate,46.94,108.99,
K WIRE DSDS1011,5645742,CDM,270,RC,,,Outpatient,,,122,97.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,97.6,80,,78.08,percent of total billed charges,80% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% of total billed charges,45.47,37.27,,36.38,percent of total billed charges,37.27% 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,48.8,40,,39.04,percent of total billed charges,40% of total billed charges,45.47,97.6,
SCREW D1N35036S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,591,472.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472.8,80,,378.24,percent of total billed charges,80% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% 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,236.4,40,,189.12,percent of total billed charges,40% of total billed charges,220.27,472.8,
SCREW D1N35046S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,591,472.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472.8,80,,378.24,percent of total billed charges,80% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% 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,236.4,40,,189.12,percent of total billed charges,40% of total billed charges,220.27,472.8,
SCREW D2N25012,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,718,574.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,574.4,80,,459.52,percent of total billed charges,80% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% 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,287.2,40,,229.76,percent of total billed charges,40% of total billed charges,267.6,574.4,
SCREW AR8724V18,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,404,323.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,323.2,80,,258.56,percent of total billed charges,80% of total billed charges,150.57,37.27,,120.46,percent of total billed charges,37.27% of total billed charges,150.57,37.27,,120.46,percent of total billed charges,37.27% of total billed charges,150.57,37.27,,120.46,percent of total billed charges,37.27% 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,161.6,40,,129.28,percent of total billed charges,40% of total billed charges,150.57,323.2,
SCREW AR8724V22,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,404,323.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,323.2,80,,258.56,percent of total billed charges,80% of total billed charges,150.57,37.27,,120.46,percent of total billed charges,37.27% of total billed charges,150.57,37.27,,120.46,percent of total billed charges,37.27% of total billed charges,150.57,37.27,,120.46,percent of total billed charges,37.27% 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,161.6,40,,129.28,percent of total billed charges,40% of total billed charges,150.57,323.2,
SCREW AR873514,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,173,138.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% 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,69.2,40,,55.36,percent of total billed charges,40% of total billed charges,64.48,138.4,
GUIDE AR891601,8605396,CDM,278,RC,C1769,HCPCS,Outpatient,,,1227,981.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,981.6,80,,785.28,percent of total billed charges,80% of total billed charges,457.3,37.27,,365.84,percent of total billed charges,37.27% of total billed charges,457.3,37.27,,365.84,percent of total billed charges,37.27% of total billed charges,457.3,37.27,,365.84,percent of total billed charges,37.27% 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,490.8,40,,392.64,percent of total billed charges,40% of total billed charges,457.3,981.6,
SCREW AR8916VNC16,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,404,323.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,323.2,80,,258.56,percent of total billed charges,80% of total billed charges,150.57,37.27,,120.46,percent of total billed charges,37.27% of total billed charges,150.57,37.27,,120.46,percent of total billed charges,37.27% of total billed charges,150.57,37.27,,120.46,percent of total billed charges,37.27% 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,161.6,40,,129.28,percent of total billed charges,40% of total billed charges,150.57,323.2,
IMPLANT SYS AR2260,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2454,1963.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1963.2,80,,1570.56,percent of total billed charges,80% of total billed charges,914.61,37.27,,731.69,percent of total billed charges,37.27% of total billed charges,914.61,37.27,,731.69,percent of total billed charges,37.27% of total billed charges,914.61,37.27,,731.69,percent of total billed charges,37.27% 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,981.6,40,,785.28,percent of total billed charges,40% of total billed charges,914.61,1963.2,
SCREW D1N40038S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,718,574.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,574.4,80,,459.52,percent of total billed charges,80% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% 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,287.2,40,,229.76,percent of total billed charges,40% of total billed charges,267.6,574.4,
SCREW D1N35014S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,591,472.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472.8,80,,378.24,percent of total billed charges,80% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% 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,236.4,40,,189.12,percent of total billed charges,40% of total billed charges,220.27,472.8,
PREVNAR-20,6065130,CDM,636,RC,90677,HCPCS,Outpatient,,,1891.2,1512.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1512.96,80,,1210.37,percent of total billed charges,80% of total billed charges,704.85,37.27,,563.88,percent of total billed charges,37.27% of total billed charges,704.85,37.27,,563.88,percent of total billed charges,37.27% of total billed charges,704.85,37.27,,563.88,percent of total billed charges,37.27% 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,756.48,40,,605.18,percent of total billed charges,40% of total billed charges,704.85,1512.96,
DRILL BIT 705077S,5801832,CDM,272,RC,,,Outpatient,,,884,707.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,707.2,80,,565.76,percent of total billed charges,80% of total billed charges,329.47,37.27,,263.58,percent of total billed charges,37.27% of total billed charges,329.47,37.27,,263.58,percent of total billed charges,37.27% of total billed charges,329.47,37.27,,263.58,percent of total billed charges,37.27% 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,353.6,40,,282.88,percent of total billed charges,40% of total billed charges,329.47,707.2,
DRILL SLEEVE 705004,5801832,CDM,272,RC,,,Outpatient,,,815,652.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,652,80,,521.6,percent of total billed charges,80% of total billed charges,303.75,37.27,,243,percent of total billed charges,37.27% of total billed charges,303.75,37.27,,243,percent of total billed charges,37.27% of total billed charges,303.75,37.27,,243,percent of total billed charges,37.27% 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,326,40,,260.8,percent of total billed charges,40% of total billed charges,303.75,652,
PLATE 627454,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5988,4790.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4790.4,80,,3832.32,percent of total billed charges,80% of total billed charges,2231.73,37.27,,1785.38,percent of total billed charges,37.27% of total billed charges,2231.73,37.27,,1785.38,percent of total billed charges,37.27% of total billed charges,2231.73,37.27,,1785.38,percent of total billed charges,37.27% 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,2395.2,40,,1916.16,percent of total billed charges,40% of total billed charges,2231.73,4790.4,
SCREW 607450,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,121,96.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% 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,48.4,40,,38.72,percent of total billed charges,40% of total billed charges,45.1,96.8,
SCREW 607448,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,121,96.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% 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,48.4,40,,38.72,percent of total billed charges,40% of total billed charges,45.1,96.8,
SCREW 607444,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,121,96.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% 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,48.4,40,,38.72,percent of total billed charges,40% of total billed charges,45.1,96.8,
SCREW 607440,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,121,96.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,96.8,80,,77.44,percent of total billed charges,80% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% of total billed charges,45.1,37.27,,36.08,percent of total billed charges,37.27% 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,48.4,40,,38.72,percent of total billed charges,40% of total billed charges,45.1,96.8,
SCREW 661430,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,110,88.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88,80,,70.4,percent of total billed charges,80% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% of total billed charges,41,37.27,,32.8,percent of total billed charges,37.27% 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,44,40,,35.2,percent of total billed charges,40% of total billed charges,41,88,
SCREW 661044,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,535,428.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428,80,,342.4,percent of total billed charges,80% of total billed charges,199.39,37.27,,159.51,percent of total billed charges,37.27% of total billed charges,199.39,37.27,,159.51,percent of total billed charges,37.27% of total billed charges,199.39,37.27,,159.51,percent of total billed charges,37.27% 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,214,40,,171.2,percent of total billed charges,40% of total billed charges,199.39,428,
SCREW 661046,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,535,428.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428,80,,342.4,percent of total billed charges,80% of total billed charges,199.39,37.27,,159.51,percent of total billed charges,37.27% of total billed charges,199.39,37.27,,159.51,percent of total billed charges,37.27% of total billed charges,199.39,37.27,,159.51,percent of total billed charges,37.27% 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,214,40,,171.2,percent of total billed charges,40% of total billed charges,199.39,428,
SCREW 661050,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,535,428.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428,80,,342.4,percent of total billed charges,80% of total billed charges,199.39,37.27,,159.51,percent of total billed charges,37.27% of total billed charges,199.39,37.27,,159.51,percent of total billed charges,37.27% of total billed charges,199.39,37.27,,159.51,percent of total billed charges,37.27% 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,214,40,,171.2,percent of total billed charges,40% of total billed charges,199.39,428,
PLATE 161232,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
TIB BEAR 5531G610E,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
DRILL BIT 310509,5801832,CDM,272,RC,,,Outpatient,,,1018,814.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,814.4,80,,651.52,percent of total billed charges,80% of total billed charges,379.41,37.27,,303.53,percent of total billed charges,37.27% of total billed charges,379.41,37.27,,303.53,percent of total billed charges,37.27% of total billed charges,379.41,37.27,,303.53,percent of total billed charges,37.27% 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,407.2,40,,325.76,percent of total billed charges,40% of total billed charges,379.41,814.4,
PLATE 249674,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2679,2143.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2143.2,80,,1714.56,percent of total billed charges,80% of total billed charges,998.46,37.27,,798.77,percent of total billed charges,37.27% of total billed charges,998.46,37.27,,798.77,percent of total billed charges,37.27% of total billed charges,998.46,37.27,,798.77,percent of total billed charges,37.27% 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,1071.6,40,,857.28,percent of total billed charges,40% of total billed charges,998.46,2143.2,
SCREW 02210110,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1034,827.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,827.2,80,,661.76,percent of total billed charges,80% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% 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,413.6,40,,330.88,percent of total billed charges,40% of total billed charges,385.37,827.2,
SCREW 02210111,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1034,827.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,827.2,80,,661.76,percent of total billed charges,80% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% 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,413.6,40,,330.88,percent of total billed charges,40% of total billed charges,385.37,827.2,
SCREW 201762,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,426,340.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,340.8,80,,272.64,percent of total billed charges,80% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% of total billed charges,158.77,37.27,,127.02,percent of total billed charges,37.27% 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,170.4,40,,136.32,percent of total billed charges,40% of total billed charges,158.77,340.8,
SCREW 02210112,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1034,827.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,827.2,80,,661.76,percent of total billed charges,80% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% of total billed charges,385.37,37.27,,308.3,percent of total billed charges,37.27% 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,413.6,40,,330.88,percent of total billed charges,40% of total billed charges,385.37,827.2,
MRI ABD & MRI ELASTR,6212047,CDM,610,RC,,,Outpatient,,,4214,3371.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3371.2,80,,2696.96,percent of total billed charges,80% of total billed charges,1570.56,37.27,,1256.45,percent of total billed charges,37.27% of total billed charges,1570.56,37.27,,1256.45,percent of total billed charges,37.27% of total billed charges,1570.56,37.27,,1256.45,percent of total billed charges,37.27% 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,1685.6,40,,1348.48,percent of total billed charges,40% of total billed charges,1570.56,3371.2,
FLUVOXAMINE 25MG TAB,5880901,CDM,637,RC,,,Outpatient,,,7.85,6.28,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6.28,80,,5.02,percent of total billed charges,80% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% of total billed charges,2.93,37.27,,2.34,percent of total billed charges,37.27% 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,3.14,40,,2.51,percent of total billed charges,40% of total billed charges,2.93,6.28,
PROGESTERONE 200MG,6400014,CDM,250,RC,,,Outpatient,,,33.5,26.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.8,80,,21.44,percent of total billed charges,80% of total billed charges,12.49,37.27,,9.99,percent of total billed charges,37.27% of total billed charges,12.49,37.27,,9.99,percent of total billed charges,37.27% of total billed charges,12.49,37.27,,9.99,percent of total billed charges,37.27% 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,13.4,40,,10.72,percent of total billed charges,40% of total billed charges,12.49,26.8,
DRILL BIT MHP016,5801832,CDM,272,RC,,,Outpatient,,,1405,1124.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1124,80,,899.2,percent of total billed charges,80% of total billed charges,523.64,37.27,,418.91,percent of total billed charges,37.27% of total billed charges,523.64,37.27,,418.91,percent of total billed charges,37.27% of total billed charges,523.64,37.27,,418.91,percent of total billed charges,37.27% 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,562,40,,449.6,percent of total billed charges,40% of total billed charges,523.64,1124,
PLATE SPS003,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,6523,5218.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5218.4,80,,4174.72,percent of total billed charges,80% of total billed charges,2431.12,37.27,,1944.9,percent of total billed charges,37.27% of total billed charges,2431.12,37.27,,1944.9,percent of total billed charges,37.27% of total billed charges,2431.12,37.27,,1944.9,percent of total billed charges,37.27% 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,2609.2,40,,2087.36,percent of total billed charges,40% of total billed charges,2431.12,5218.4,
SCREW SPS436,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,457,365.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,365.6,80,,292.48,percent of total billed charges,80% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% 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,182.8,40,,146.24,percent of total billed charges,40% of total billed charges,170.32,365.6,
SCREW SPS432,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,457,365.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,365.6,80,,292.48,percent of total billed charges,80% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% 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,182.8,40,,146.24,percent of total billed charges,40% of total billed charges,170.32,365.6,
SCREW SPS430,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,457,365.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,365.6,80,,292.48,percent of total billed charges,80% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% 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,182.8,40,,146.24,percent of total billed charges,40% of total billed charges,170.32,365.6,
SCREW SPS442,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,457,365.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,365.6,80,,292.48,percent of total billed charges,80% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% 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,182.8,40,,146.24,percent of total billed charges,40% of total billed charges,170.32,365.6,
SCREW SPS434,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,457,365.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,365.6,80,,292.48,percent of total billed charges,80% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% 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,182.8,40,,146.24,percent of total billed charges,40% of total billed charges,170.32,365.6,
SCREW SPS438,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,457,365.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,365.6,80,,292.48,percent of total billed charges,80% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% 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,182.8,40,,146.24,percent of total billed charges,40% of total billed charges,170.32,365.6,
SCREW SPS428,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,457,365.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,365.6,80,,292.48,percent of total billed charges,80% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% 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,182.8,40,,146.24,percent of total billed charges,40% of total billed charges,170.32,365.6,
SCREW SPS230,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,459,367.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,367.2,80,,293.76,percent of total billed charges,80% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% 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,183.6,40,,146.88,percent of total billed charges,40% of total billed charges,171.07,367.2,
SCREW SPS228,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,459,367.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,367.2,80,,293.76,percent of total billed charges,80% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% 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,183.6,40,,146.88,percent of total billed charges,40% of total billed charges,171.07,367.2,
SCREW SPS220,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,459,367.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,367.2,80,,293.76,percent of total billed charges,80% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% 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,183.6,40,,146.88,percent of total billed charges,40% of total billed charges,171.07,367.2,
SCREW SPS222,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,459,367.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,367.2,80,,293.76,percent of total billed charges,80% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% 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,183.6,40,,146.88,percent of total billed charges,40% of total billed charges,171.07,367.2,
SCREW SPS224,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,459,367.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,367.2,80,,293.76,percent of total billed charges,80% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% of total billed charges,171.07,37.27,,136.86,percent of total billed charges,37.27% 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,183.6,40,,146.88,percent of total billed charges,40% of total billed charges,171.07,367.2,
STELARA 130MG IV,6065130,CDM,636,RC,J3358,HCPCS,Outpatient,,,74.75,59.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,59.8,80,,47.84,percent of total billed charges,80% of total billed charges,27.86,37.27,,22.29,percent of total billed charges,37.27% of total billed charges,27.86,37.27,,22.29,percent of total billed charges,37.27% of total billed charges,27.86,37.27,,22.29,percent of total billed charges,37.27% of total billed charges,12.97,100,,,fee schedule,100% of APC rate,12.97,100,,,fee schedule,100% of APC rate,12.97,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,12.97,100,,,fee schedule,100% of APC rate,12.97,100,,,fee schedule,100% of APC rate,12.97,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,29.9,40,,23.92,percent of total billed charges,40% of total billed charges,12.97,59.8,
THORACOLUMBAR SPI 1V,6000392,CDM,320,RC,72020,HCPCS,Outpatient,,,350,280.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,80,,224,percent of total billed charges,80% of total billed charges,130.45,37.27,,104.36,percent of total billed charges,37.27% of total billed charges,130.45,37.27,,104.36,percent of total billed charges,37.27% of total billed charges,130.45,37.27,,104.36,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,21.26,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140,40,,112,percent of total billed charges,40% of total billed charges,21.26,280,
THORACOLUMBAR SP 2V,6000392,CDM,320,RC,72080,HCPCS,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,31.41,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110,40,,88,percent of total billed charges,40% of total billed charges,31.41,220,
FEM HEAD 5510F301,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4950,3960.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3960,80,,3168,percent of total billed charges,80% of total billed charges,1844.87,37.27,,1475.9,percent of total billed charges,37.27% of total billed charges,1844.87,37.27,,1475.9,percent of total billed charges,37.27% of total billed charges,1844.87,37.27,,1475.9,percent of total billed charges,37.27% 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,1980,40,,1584,percent of total billed charges,40% of total billed charges,1844.87,3960,
TIB BEAR 55316309E,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
PATELLA 55516299E,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,1348,1078.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1078.4,80,,862.72,percent of total billed charges,80% of total billed charges,502.4,37.27,,401.92,percent of total billed charges,37.27% of total billed charges,502.4,37.27,,401.92,percent of total billed charges,37.27% of total billed charges,502.4,37.27,,401.92,percent of total billed charges,37.27% 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,539.2,40,,431.36,percent of total billed charges,40% of total billed charges,502.4,1078.4,
SCREW D1N40048S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,737,589.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,589.6,80,,471.68,percent of total billed charges,80% of total billed charges,274.68,37.27,,219.74,percent of total billed charges,37.27% of total billed charges,274.68,37.27,,219.74,percent of total billed charges,37.27% of total billed charges,274.68,37.27,,219.74,percent of total billed charges,37.27% 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,294.8,40,,235.84,percent of total billed charges,40% of total billed charges,274.68,589.6,
SCREW D1N25028S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,564,451.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,451.2,80,,360.96,percent of total billed charges,80% of total billed charges,210.2,37.27,,168.16,percent of total billed charges,37.27% of total billed charges,210.2,37.27,,168.16,percent of total billed charges,37.27% of total billed charges,210.2,37.27,,168.16,percent of total billed charges,37.27% 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,225.6,40,,180.48,percent of total billed charges,40% of total billed charges,210.2,451.2,
US BLADDER,6000566,CDM,402,RC,76857,HCPCS,Outpatient,,,720,576.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,33.52,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,40,,230.4,percent of total billed charges,40% of total billed charges,33.52,576,
PEEK MENISCA AR4550P,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4028,3222.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3222.4,80,,2577.92,percent of total billed charges,80% of total billed charges,1501.24,37.27,,1200.99,percent of total billed charges,37.27% of total billed charges,1501.24,37.27,,1200.99,percent of total billed charges,37.27% of total billed charges,1501.24,37.27,,1200.99,percent of total billed charges,37.27% 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,1611.2,40,,1288.96,percent of total billed charges,40% of total billed charges,1501.24,3222.4,
MRI TEMPOROMAN WO,6212047,CDM,610,RC,70336,HCPCS,Outpatient,,,3564,2851.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2851.2,80,,2280.96,percent of total billed charges,80% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,1328.3,37.27,,1062.64,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,257.33,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1425.6,40,,1140.48,percent of total billed charges,40% of total billed charges,202.03,2851.2,
MRA ABDOMEN W CONTRA,,,618,RC,74185,HCPCS,Outpatient,,,3016,2412.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2412.8,80,,1930.24,percent of total billed charges,80% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,1124.06,37.27,,899.25,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,334.11,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1206.4,40,,965.12,percent of total billed charges,40% of total billed charges,334.11,2412.8,
TRAVOPROST OPH SOL,6400014,CDM,250,RC,,,Outpatient,,,609.95,487.96,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,487.96,80,,390.37,percent of total billed charges,80% of total billed charges,227.33,37.27,,181.86,percent of total billed charges,37.27% of total billed charges,227.33,37.27,,181.86,percent of total billed charges,37.27% of total billed charges,227.33,37.27,,181.86,percent of total billed charges,37.27% 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,243.98,40,,195.18,percent of total billed charges,40% of total billed charges,227.33,487.96,
ACETAB 122136456,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4881,3904.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3904.8,80,,3123.84,percent of total billed charges,80% of total billed charges,1819.15,37.27,,1455.32,percent of total billed charges,37.27% of total billed charges,1819.15,37.27,,1455.32,percent of total billed charges,37.27% of total billed charges,1819.15,37.27,,1455.32,percent of total billed charges,37.27% 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,1952.4,40,,1561.92,percent of total billed charges,40% of total billed charges,1819.15,3904.8,
FEM STEM 157001110,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2481,1984.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1984.8,80,,1587.84,percent of total billed charges,80% of total billed charges,924.67,37.27,,739.74,percent of total billed charges,37.27% of total billed charges,924.67,37.27,,739.74,percent of total billed charges,37.27% of total billed charges,924.67,37.27,,739.74,percent of total billed charges,37.27% 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,992.4,40,,793.92,percent of total billed charges,40% of total billed charges,924.67,1984.8,
ACETAB 121730060,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4546,3636.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3636.8,80,,2909.44,percent of total billed charges,80% of total billed charges,1694.29,37.27,,1355.43,percent of total billed charges,37.27% of total billed charges,1694.29,37.27,,1355.43,percent of total billed charges,37.27% of total billed charges,1694.29,37.27,,1355.43,percent of total billed charges,37.27% 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,1818.4,40,,1454.72,percent of total billed charges,40% of total billed charges,1694.29,3636.8,
ACETAB 122136460,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2272,1817.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1817.6,80,,1454.08,percent of total billed charges,80% of total billed charges,846.77,37.27,,677.42,percent of total billed charges,37.27% of total billed charges,846.77,37.27,,677.42,percent of total billed charges,37.27% of total billed charges,846.77,37.27,,677.42,percent of total billed charges,37.27% 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,908.8,40,,727.04,percent of total billed charges,40% of total billed charges,846.77,1817.6,
FEM HEAD 136552000,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,1650,1320.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1320,80,,1056,percent of total billed charges,80% of total billed charges,614.96,37.27,,491.97,percent of total billed charges,37.27% of total billed charges,614.96,37.27,,491.97,percent of total billed charges,37.27% of total billed charges,614.96,37.27,,491.97,percent of total billed charges,37.27% 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,660,40,,528,percent of total billed charges,40% of total billed charges,614.96,1320,
SCREW 121715500,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
SCREW 51191742,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2310,1848.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1848,80,,1478.4,percent of total billed charges,80% of total billed charges,860.94,37.27,,688.75,percent of total billed charges,37.27% of total billed charges,860.94,37.27,,688.75,percent of total billed charges,37.27% of total billed charges,860.94,37.27,,688.75,percent of total billed charges,37.27% 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,924,40,,739.2,percent of total billed charges,40% of total billed charges,860.94,1848,
ROD 71197045,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,721,576.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576.8,80,,461.44,percent of total billed charges,80% of total billed charges,268.72,37.27,,214.98,percent of total billed charges,37.27% of total billed charges,268.72,37.27,,214.98,percent of total billed charges,37.27% of total billed charges,268.72,37.27,,214.98,percent of total billed charges,37.27% 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,288.4,40,,230.72,percent of total billed charges,40% of total billed charges,268.72,576.8,
ROD 71197050,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,721,576.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576.8,80,,461.44,percent of total billed charges,80% of total billed charges,268.72,37.27,,214.98,percent of total billed charges,37.27% of total billed charges,268.72,37.27,,214.98,percent of total billed charges,37.27% of total billed charges,268.72,37.27,,214.98,percent of total billed charges,37.27% 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,288.4,40,,230.72,percent of total billed charges,40% of total billed charges,268.72,576.8,
SCREW 51191747,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2310,1848.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1848,80,,1478.4,percent of total billed charges,80% of total billed charges,860.94,37.27,,688.75,percent of total billed charges,37.27% of total billed charges,860.94,37.27,,688.75,percent of total billed charges,37.27% of total billed charges,860.94,37.27,,688.75,percent of total billed charges,37.27% 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,924,40,,739.2,percent of total billed charges,40% of total billed charges,860.94,1848,
SPACER 11724110S,8605396,CDM,278,RC,,,Outpatient,,,18768.75,15015.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,15015,80,,12012,percent of total billed charges,80% of total billed charges,6995.11,37.27,,5596.09,percent of total billed charges,37.27% of total billed charges,6995.11,37.27,,5596.09,percent of total billed charges,37.27% of total billed charges,6995.11,37.27,,5596.09,percent of total billed charges,37.27% 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,7507.5,40,,6006,percent of total billed charges,40% of total billed charges,6995.11,15015,
ROD 71197040,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,721,576.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576.8,80,,461.44,percent of total billed charges,80% of total billed charges,268.72,37.27,,214.98,percent of total billed charges,37.27% of total billed charges,268.72,37.27,,214.98,percent of total billed charges,37.27% of total billed charges,268.72,37.27,,214.98,percent of total billed charges,37.27% 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,288.4,40,,230.72,percent of total billed charges,40% of total billed charges,268.72,576.8,
SCREW 121720500,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,278,222.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,222.4,80,,177.92,percent of total billed charges,80% of total billed charges,103.61,37.27,,82.89,percent of total billed charges,37.27% of total billed charges,103.61,37.27,,82.89,percent of total billed charges,37.27% of total billed charges,103.61,37.27,,82.89,percent of total billed charges,37.27% 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,111.2,40,,88.96,percent of total billed charges,40% of total billed charges,103.61,222.4,
CLINIMIX 5/20 (TPN),6400014,CDM,250,RC,,,Outpatient,,,1,0.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,0.8,80,,0.64,percent of total billed charges,80% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% of total billed charges,0.37,37.27,,0.3,percent of total billed charges,37.27% 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,0.4,40,,0.32,percent of total billed charges,40% of total billed charges,0.37,0.8,
LEVOPHED 4MG PREMIX,6065130,CDM,636,RC,J1960,HCPCS,Outpatient,,,151.4,121.12,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,121.12,80,,96.9,percent of total billed charges,80% of total billed charges,56.43,37.27,,45.14,percent of total billed charges,37.27% of total billed charges,56.43,37.27,,45.14,percent of total billed charges,37.27% of total billed charges,56.43,37.27,,45.14,percent of total billed charges,37.27% 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,60.56,40,,48.45,percent of total billed charges,40% of total billed charges,56.43,121.12,
SPACER 12112416S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5756,4604.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4604.8,80,,3683.84,percent of total billed charges,80% of total billed charges,2145.26,37.27,,1716.21,percent of total billed charges,37.27% of total billed charges,2145.26,37.27,,1716.21,percent of total billed charges,37.27% of total billed charges,2145.26,37.27,,1716.21,percent of total billed charges,37.27% 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,2302.4,40,,1841.92,percent of total billed charges,40% of total billed charges,2145.26,4604.8,
CANNULA AR65920830,5645742,CDM,270,RC,,,Outpatient,,,93,74.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,74.4,80,,59.52,percent of total billed charges,80% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% of total billed charges,34.66,37.27,,27.73,percent of total billed charges,37.27% 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,37.2,40,,29.76,percent of total billed charges,40% of total billed charges,34.66,74.4,
FIBERTAPE AR723717LN,5645742,CDM,270,RC,,,Outpatient,,,563,450.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,450.4,80,,360.32,percent of total billed charges,80% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% 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,225.2,40,,180.16,percent of total billed charges,40% of total billed charges,209.83,450.4,
STIOLTO RESPIMAT,6400014,CDM,250,RC,,,Outpatient,,,234.9,187.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,187.92,80,,150.34,percent of total billed charges,80% of total billed charges,87.55,37.27,,70.04,percent of total billed charges,37.27% of total billed charges,87.55,37.27,,70.04,percent of total billed charges,37.27% of total billed charges,87.55,37.27,,70.04,percent of total billed charges,37.27% 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,93.96,40,,75.17,percent of total billed charges,40% of total billed charges,87.55,187.92,
SPACER 31361106,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,7219,5775.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5775.2,80,,4620.16,percent of total billed charges,80% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% 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,2887.6,40,,2310.08,percent of total billed charges,40% of total billed charges,2690.52,5775.2,
SCREW 184152,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1488,1190.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1190.4,80,,952.32,percent of total billed charges,80% of total billed charges,554.58,37.27,,443.66,percent of total billed charges,37.27% of total billed charges,554.58,37.27,,443.66,percent of total billed charges,37.27% of total billed charges,554.58,37.27,,443.66,percent of total billed charges,37.27% 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,595.2,40,,476.16,percent of total billed charges,40% of total billed charges,554.58,1190.4,
ZYNRELEF 400MG,6065130,CDM,636,RC,C9088,HCPCS,Outpatient,,,86.15,68.92,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68.92,80,,55.14,percent of total billed charges,80% of total billed charges,32.11,37.27,,25.69,percent of total billed charges,37.27% of total billed charges,32.11,37.27,,25.69,percent of total billed charges,37.27% of total billed charges,32.11,37.27,,25.69,percent of total billed charges,37.27% of total billed charges,0.77,100,,,fee schedule,100% of APC rate,0.77,100,,,fee schedule,100% of APC rate,0.77,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,0.77,100,,,fee schedule,100% of APC rate,0.77,100,,,fee schedule,100% of APC rate,0.77,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34.46,40,,27.57,percent of total billed charges,40% of total billed charges,0.77,68.92,
FEM STEM L971309,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4881,3904.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3904.8,80,,3123.84,percent of total billed charges,80% of total billed charges,1819.15,37.27,,1455.32,percent of total billed charges,37.27% of total billed charges,1819.15,37.27,,1455.32,percent of total billed charges,37.27% of total billed charges,1819.15,37.27,,1455.32,percent of total billed charges,37.27% 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,1952.4,40,,1561.92,percent of total billed charges,40% of total billed charges,1819.15,3904.8,
FEM HEAD 136532310,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2481,1984.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1984.8,80,,1587.84,percent of total billed charges,80% of total billed charges,924.67,37.27,,739.74,percent of total billed charges,37.27% of total billed charges,924.67,37.27,,739.74,percent of total billed charges,37.27% of total billed charges,924.67,37.27,,739.74,percent of total billed charges,37.27% 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,992.4,40,,793.92,percent of total billed charges,40% of total billed charges,924.67,1984.8,
BEARING INS 5531-G-5,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,3025,2420.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
PIN HEADLESS 7650-20,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1240,992.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,992,80,,793.6,percent of total billed charges,80% of total billed charges,462.15,37.27,,369.72,percent of total billed charges,37.27% of total billed charges,462.15,37.27,,369.72,percent of total billed charges,37.27% of total billed charges,462.15,37.27,,369.72,percent of total billed charges,37.27% 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,496,40,,396.8,percent of total billed charges,40% of total billed charges,462.15,992,
RETAIN FEMORAL 5517-,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,6600,5280.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5280,80,,4224,percent of total billed charges,80% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% 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,2640,40,,2112,percent of total billed charges,40% of total billed charges,2459.82,5280,
TIBIAL COMP 5536-B-3,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4400,3520.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3520,80,,2816,percent of total billed charges,80% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% 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,1760,40,,1408,percent of total billed charges,40% of total billed charges,1639.88,3520,
BEARING INS 5531-G-3,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,3025,2420.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
HIP SH 50M 121732050,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4463,3570.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3570.4,80,,2856.32,percent of total billed charges,80% of total billed charges,1663.36,37.27,,1330.69,percent of total billed charges,37.27% of total billed charges,1663.36,37.27,,1330.69,percent of total billed charges,37.27% of total billed charges,1663.36,37.27,,1330.69,percent of total billed charges,37.27% 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,1785.2,40,,1428.16,percent of total billed charges,40% of total billed charges,1663.36,3570.4,
SHLDR 20-8090-004-02,5801832,CDM,272,RC,,,Outpatient,,,3713,2970.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2970.4,80,,2376.32,percent of total billed charges,80% of total billed charges,1383.84,37.27,,1107.07,percent of total billed charges,37.27% of total billed charges,1383.84,37.27,,1107.07,percent of total billed charges,37.27% of total billed charges,1383.84,37.27,,1107.07,percent of total billed charges,37.27% 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,1485.2,40,,1188.16,percent of total billed charges,40% of total billed charges,1383.84,2970.4,
PIN 405800,5801832,CDM,272,RC,,,Outpatient,,,413,330.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% 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,165.2,40,,132.16,percent of total billed charges,40% of total billed charges,153.93,330.4,
DRILL BIT 405883,5801832,CDM,272,RC,,,Outpatient,,,413,330.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,330.4,80,,264.32,percent of total billed charges,80% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% of total billed charges,153.93,37.27,,123.14,percent of total billed charges,37.27% 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,165.2,40,,132.16,percent of total billed charges,40% of total billed charges,153.93,330.4,
DRILL BIT 405889,5801832,CDM,272,RC,,,Outpatient,,,481,384.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,384.8,80,,307.84,percent of total billed charges,80% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% of total billed charges,179.27,37.27,,143.42,percent of total billed charges,37.27% 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,192.4,40,,153.92,percent of total billed charges,40% of total billed charges,179.27,384.8,
AUG BSEPLT 110032410,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,7219,5775.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5775.2,80,,4620.16,percent of total billed charges,80% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% 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,2887.6,40,,2310.08,percent of total billed charges,40% of total billed charges,2690.52,5775.2,
DRILL BIT 32-486265,5801832,CDM,272,RC,,,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% 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,198,40,,158.4,percent of total billed charges,40% of total billed charges,184.49,396,
COMP REV SHDR 115310,5801832,CDM,272,RC,,,Outpatient,,,4180,3344.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3344,80,,2675.2,percent of total billed charges,80% of total billed charges,1557.89,37.27,,1246.31,percent of total billed charges,37.27% of total billed charges,1557.89,37.27,,1246.31,percent of total billed charges,37.27% of total billed charges,1557.89,37.27,,1246.31,percent of total billed charges,37.27% 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,1672,40,,1337.6,percent of total billed charges,40% of total billed charges,1557.89,3344,
PRIM SHDR STM 113609,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,9625,7700.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7700,80,,6160,percent of total billed charges,80% of total billed charges,3587.24,37.27,,2869.79,percent of total billed charges,37.27% of total billed charges,3587.24,37.27,,2869.79,percent of total billed charges,37.27% of total billed charges,3587.24,37.27,,2869.79,percent of total billed charges,37.27% 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,3850,40,,3080,percent of total billed charges,40% of total billed charges,3587.24,7700,
HRML TRAY 110031402,8605396,CDM,278,RC,,,Outpatient,,,4125,3300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3300,80,,2640,percent of total billed charges,80% of total billed charges,1537.39,37.27,,1229.91,percent of total billed charges,37.27% of total billed charges,1537.39,37.27,,1229.91,percent of total billed charges,37.27% of total billed charges,1537.39,37.27,,1229.91,percent of total billed charges,37.27% 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,1650,40,,1320,percent of total billed charges,40% of total billed charges,1537.39,3300,
HMRL BERIN 110031424,8605396,CDM,278,RC,,,Outpatient,,,4249,3399.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3399.2,80,,2719.36,percent of total billed charges,80% of total billed charges,1583.6,37.27,,1266.88,percent of total billed charges,37.27% of total billed charges,1583.6,37.27,,1266.88,percent of total billed charges,37.27% of total billed charges,1583.6,37.27,,1266.88,percent of total billed charges,37.27% 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,1699.6,40,,1359.68,percent of total billed charges,40% of total billed charges,1583.6,3399.2,
SCREW 115396,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,179,143.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% 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,71.6,40,,57.28,percent of total billed charges,40% of total billed charges,66.71,143.2,
SCREW 180550,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,179,143.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% 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,71.6,40,,57.28,percent of total billed charges,40% of total billed charges,66.71,143.2,
SCREW 180552,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,179,143.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,143.2,80,,114.56,percent of total billed charges,80% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% of total billed charges,66.71,37.27,,53.37,percent of total billed charges,37.27% 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,71.6,40,,57.28,percent of total billed charges,40% of total billed charges,66.71,143.2,
FLEX SHOUL SYSTEM,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,24750,19800.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19800,80,,15840,percent of total billed charges,80% of total billed charges,9224.33,37.27,,7379.46,percent of total billed charges,37.27% of total billed charges,9224.33,37.27,,7379.46,percent of total billed charges,37.27% of total billed charges,9224.33,37.27,,7379.46,percent of total billed charges,37.27% 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,9900,40,,7920,percent of total billed charges,40% of total billed charges,9224.33,19800,
SCREW 604628S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,546,436.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,436.8,80,,349.44,percent of total billed charges,80% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% 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,218.4,40,,174.72,percent of total billed charges,40% of total billed charges,203.49,436.8,
SCREW 604630S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,546,436.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,436.8,80,,349.44,percent of total billed charges,80% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% 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,218.4,40,,174.72,percent of total billed charges,40% of total billed charges,203.49,436.8,
DRILL BIT 6149.1035,5801832,CDM,272,RC,,,Outpatient,,,1359,1087.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1087.2,80,,869.76,percent of total billed charges,80% of total billed charges,506.5,37.27,,405.2,percent of total billed charges,37.27% of total billed charges,506.5,37.27,,405.2,percent of total billed charges,37.27% of total billed charges,506.5,37.27,,405.2,percent of total billed charges,37.27% 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,543.6,40,,434.88,percent of total billed charges,40% of total billed charges,506.5,1087.2,
TAP SCREW 6149.1135,5801832,CDM,272,RC,,,Outpatient,,,1837,1469.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1469.6,80,,1175.68,percent of total billed charges,80% of total billed charges,684.65,37.27,,547.72,percent of total billed charges,37.27% of total billed charges,684.65,37.27,,547.72,percent of total billed charges,37.27% of total billed charges,684.65,37.27,,547.72,percent of total billed charges,37.27% 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,734.8,40,,587.84,percent of total billed charges,40% of total billed charges,684.65,1469.6,
CURVED ROD 1149.7535,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,869,695.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,695.2,80,,556.16,percent of total billed charges,80% of total billed charges,323.88,37.27,,259.1,percent of total billed charges,37.27% of total billed charges,323.88,37.27,,259.1,percent of total billed charges,37.27% of total billed charges,323.88,37.27,,259.1,percent of total billed charges,37.27% 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,347.6,40,,278.08,percent of total billed charges,40% of total billed charges,323.88,695.2,
OMEGA 3.9MM ANCHOR,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1334,1067.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1067.2,80,,853.76,percent of total billed charges,80% of total billed charges,497.18,37.27,,397.74,percent of total billed charges,37.27% of total billed charges,497.18,37.27,,397.74,percent of total billed charges,37.27% of total billed charges,497.18,37.27,,397.74,percent of total billed charges,37.27% 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,533.6,40,,426.88,percent of total billed charges,40% of total billed charges,497.18,1067.2,
TAP 3.9MM 3910947205,5801832,CDM,272,RC,,,Outpatient,,,693,554.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,554.4,80,,443.52,percent of total billed charges,80% of total billed charges,258.28,37.27,,206.62,percent of total billed charges,37.27% of total billed charges,258.28,37.27,,206.62,percent of total billed charges,37.27% of total billed charges,258.28,37.27,,206.62,percent of total billed charges,37.27% 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,277.2,40,,221.76,percent of total billed charges,40% of total billed charges,258.28,554.4,
PLATE 26MM 161126,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2742,2193.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2193.6,80,,1754.88,percent of total billed charges,80% of total billed charges,1021.94,37.27,,817.55,percent of total billed charges,37.27% of total billed charges,1021.94,37.27,,817.55,percent of total billed charges,37.27% of total billed charges,1021.94,37.27,,817.55,percent of total billed charges,37.27% 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,1096.8,40,,877.44,percent of total billed charges,40% of total billed charges,1021.94,2193.6,
SCREW AR8724VCL22,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
SCREW AR8724VCL24,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
PLATE AR8916VNL05,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2295.57,1836.46,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1836.46,80,,1469.17,percent of total billed charges,80% of total billed charges,855.56,37.27,,684.45,percent of total billed charges,37.27% of total billed charges,855.56,37.27,,684.45,percent of total billed charges,37.27% of total billed charges,855.56,37.27,,684.45,percent of total billed charges,37.27% 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,918.23,40,,734.58,percent of total billed charges,40% of total billed charges,855.56,1836.46,
SCREW AR893514,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,173,138.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% 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,69.2,40,,55.36,percent of total billed charges,40% of total billed charges,64.48,138.4,
SCREW AR8935CL14,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
SCREW AR8935CL16,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
FARXIGA 10MG TAB,5880901,CDM,637,RC,,,Outpatient,,,79.4,63.52,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,63.52,80,,50.82,percent of total billed charges,80% of total billed charges,29.59,37.27,,23.67,percent of total billed charges,37.27% of total billed charges,29.59,37.27,,23.67,percent of total billed charges,37.27% of total billed charges,29.59,37.27,,23.67,percent of total billed charges,37.27% 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,31.76,40,,25.41,percent of total billed charges,40% of total billed charges,29.59,63.52,
PLATE 4020906,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2240,1792.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1792,80,,1433.6,percent of total billed charges,80% of total billed charges,834.85,37.27,,667.88,percent of total billed charges,37.27% of total billed charges,834.85,37.27,,667.88,percent of total billed charges,37.27% of total billed charges,834.85,37.27,,667.88,percent of total billed charges,37.27% 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,896,40,,716.8,percent of total billed charges,40% of total billed charges,834.85,1792,
AMARYL 1MG TAB,6400014,CDM,250,RC,,,Outpatient,,,3.4,2.72,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2.72,80,,2.18,percent of total billed charges,80% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% of total billed charges,1.27,37.27,,1.02,percent of total billed charges,37.27% 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,1.36,40,,1.09,percent of total billed charges,40% of total billed charges,1.27,2.72,
SCREW D1N30014S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,550,440.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,440,80,,352,percent of total billed charges,80% of total billed charges,204.99,37.27,,163.99,percent of total billed charges,37.27% of total billed charges,204.99,37.27,,163.99,percent of total billed charges,37.27% of total billed charges,204.99,37.27,,163.99,percent of total billed charges,37.27% 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,220,40,,176,percent of total billed charges,40% of total billed charges,204.99,440,
SCREW D2N30012,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,718,574.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,574.4,80,,459.52,percent of total billed charges,80% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% 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,287.2,40,,229.76,percent of total billed charges,40% of total billed charges,267.6,574.4,
SCREW D2N30016,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,718,574.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,574.4,80,,459.52,percent of total billed charges,80% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% of total billed charges,267.6,37.27,,214.08,percent of total billed charges,37.27% 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,287.2,40,,229.76,percent of total billed charges,40% of total billed charges,267.6,574.4,
GLIDESCOPE LOPRO S1,5645742,CDM,270,RC,,,Outpatient,,,1303,1042.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1042.4,80,,833.92,percent of total billed charges,80% of total billed charges,485.63,37.27,,388.5,percent of total billed charges,37.27% of total billed charges,485.63,37.27,,388.5,percent of total billed charges,37.27% of total billed charges,485.63,37.27,,388.5,percent of total billed charges,37.27% 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,521.2,40,,416.96,percent of total billed charges,40% of total billed charges,485.63,1042.4,
GLIDESCOPE LOPRO S2,5645742,CDM,270,RC,,,Outpatient,,,1303,1042.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1042.4,80,,833.92,percent of total billed charges,80% of total billed charges,485.63,37.27,,388.5,percent of total billed charges,37.27% of total billed charges,485.63,37.27,,388.5,percent of total billed charges,37.27% of total billed charges,485.63,37.27,,388.5,percent of total billed charges,37.27% 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,521.2,40,,416.96,percent of total billed charges,40% of total billed charges,485.63,1042.4,
GLIDESCOPE LOPRO S3,5645742,CDM,270,RC,,,Outpatient,,,1078,862.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,862.4,80,,689.92,percent of total billed charges,80% of total billed charges,401.77,37.27,,321.42,percent of total billed charges,37.27% of total billed charges,401.77,37.27,,321.42,percent of total billed charges,37.27% of total billed charges,401.77,37.27,,321.42,percent of total billed charges,37.27% 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,431.2,40,,344.96,percent of total billed charges,40% of total billed charges,401.77,862.4,
GLIDESCOPE LOPRO S4,5645742,CDM,270,RC,,,Outpatient,,,1078,862.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,862.4,80,,689.92,percent of total billed charges,80% of total billed charges,401.77,37.27,,321.42,percent of total billed charges,37.27% of total billed charges,401.77,37.27,,321.42,percent of total billed charges,37.27% of total billed charges,401.77,37.27,,321.42,percent of total billed charges,37.27% 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,431.2,40,,344.96,percent of total billed charges,40% of total billed charges,401.77,862.4,
GLIDESCOPE LOPRO S2.,5645742,CDM,270,RC,,,Outpatient,,,1401,1120.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1120.8,80,,896.64,percent of total billed charges,80% of total billed charges,522.15,37.27,,417.72,percent of total billed charges,37.27% of total billed charges,522.15,37.27,,417.72,percent of total billed charges,37.27% of total billed charges,522.15,37.27,,417.72,percent of total billed charges,37.27% 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,560.4,40,,448.32,percent of total billed charges,40% of total billed charges,522.15,1120.8,
ZIO XT HOOK UP >48<7,7650120,CDM,731,RC,93242,HCPCS,Outpatient,,,100,80.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,15.34,145,,,fee schedule,145% of CMS fee schedule,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,40,,32,percent of total billed charges,40% of total billed charges,15.34,80,
ZIO HOOK UP >7D<15D,7650120,CDM,731,RC,93246,HCPCS,Outpatient,,,150,120.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,120,80,,96,percent of total billed charges,80% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,55.91,37.27,,44.73,percent of total billed charges,37.27% of total billed charges,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,15.34,145,,,fee schedule,145% of CMS fee schedule,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,33.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,60,40,,48,percent of total billed charges,40% of total billed charges,15.34,120,
LAPIPLASTY SYS1 SK12,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,11756,9404.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9404.8,80,,7523.84,percent of total billed charges,80% of total billed charges,4381.46,37.27,,3505.17,percent of total billed charges,37.27% of total billed charges,4381.46,37.27,,3505.17,percent of total billed charges,37.27% of total billed charges,4381.46,37.27,,3505.17,percent of total billed charges,37.27% 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,4702.4,40,,3761.92,percent of total billed charges,40% of total billed charges,4381.46,9404.8,
SAW BLADE SM-4011,5801832,CDM,272,RC,,,Outpatient,,,138,110.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,110.4,80,,88.32,percent of total billed charges,80% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% of total billed charges,51.43,37.27,,41.14,percent of total billed charges,37.27% 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,55.2,40,,44.16,percent of total billed charges,40% of total billed charges,51.43,110.4,
SCREW D1N25010S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,701,560.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,560.8,80,,448.64,percent of total billed charges,80% of total billed charges,261.26,37.27,,209.01,percent of total billed charges,37.27% of total billed charges,261.26,37.27,,209.01,percent of total billed charges,37.27% of total billed charges,261.26,37.27,,209.01,percent of total billed charges,37.27% 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,280.4,40,,224.32,percent of total billed charges,40% of total billed charges,261.26,560.8,
SCREW D2N25010,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,965,772.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,772,80,,617.6,percent of total billed charges,80% of total billed charges,359.66,37.27,,287.73,percent of total billed charges,37.27% of total billed charges,359.66,37.27,,287.73,percent of total billed charges,37.27% of total billed charges,359.66,37.27,,287.73,percent of total billed charges,37.27% 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,386,40,,308.8,percent of total billed charges,40% of total billed charges,359.66,772,
PUSHLOCK AR1922BCM,5801832,CDM,272,RC,C1713,HCPCS,Outpatient,,,1198,958.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,958.4,80,,766.72,percent of total billed charges,80% of total billed charges,446.49,37.27,,357.19,percent of total billed charges,37.27% of total billed charges,446.49,37.27,,357.19,percent of total billed charges,37.27% of total billed charges,446.49,37.27,,357.19,percent of total billed charges,37.27% 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,479.2,40,,383.36,percent of total billed charges,40% of total billed charges,446.49,958.4,
NEEDLE AR13999HDN,5645742,CDM,270,RC,,,Outpatient,,,536,428.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,428.8,80,,343.04,percent of total billed charges,80% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% of total billed charges,199.77,37.27,,159.82,percent of total billed charges,37.27% 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,214.4,40,,171.52,percent of total billed charges,40% of total billed charges,199.77,428.8,
IV PUSH NEW SITE,5811182,CDM,260,RC,96374,HCPCS,Outpatient,,,495,396.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,396,80,,316.8,percent of total billed charges,80% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,184.49,37.27,,147.59,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,47.84,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,198,40,,158.4,percent of total billed charges,40% of total billed charges,47.84,396,
IV INFUSION NEW SITE,5811182,CDM,260,RC,96365,HCPCS,Outpatient,,,526,420.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.8,80,,336.64,percent of total billed charges,80% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,81.26,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,210.4,40,,168.32,percent of total billed charges,40% of total billed charges,81.26,420.8,
IV HYDRA NEW SITE,5811182,CDM,260,RC,96360,HCPCS,Outpatient,,,222,177.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,177.6,80,,142.08,percent of total billed charges,80% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,82.74,37.27,,66.19,percent of total billed charges,37.27% of total billed charges,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,42.15,145,,,fee schedule,145% of CMS fee schedule,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,176.72,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,88.8,40,,71.04,percent of total billed charges,40% of total billed charges,42.15,177.6,
SPACER 31361107,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,7219,5775.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5775.2,80,,4620.16,percent of total billed charges,80% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% 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,2887.6,40,,2310.08,percent of total billed charges,40% of total billed charges,2690.52,5775.2,
SPACER 31362108,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,7219,5775.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5775.2,80,,4620.16,percent of total billed charges,80% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% 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,2887.6,40,,2310.08,percent of total billed charges,40% of total billed charges,2690.52,5775.2,
TRIATH FEM 5517F302,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,6600,5280.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5280,80,,4224,percent of total billed charges,80% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% 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,2640,40,,2112,percent of total billed charges,40% of total billed charges,2459.82,5280,
SPACER 31362107,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,7219,5775.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5775.2,80,,4620.16,percent of total billed charges,80% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% of total billed charges,2690.52,37.27,,2152.42,percent of total billed charges,37.27% 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,2887.6,40,,2310.08,percent of total billed charges,40% of total billed charges,2690.52,5775.2,
SCREW 184156,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1488,1190.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1190.4,80,,952.32,percent of total billed charges,80% of total billed charges,554.58,37.27,,443.66,percent of total billed charges,37.27% of total billed charges,554.58,37.27,,443.66,percent of total billed charges,37.27% of total billed charges,554.58,37.27,,443.66,percent of total billed charges,37.27% 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,595.2,40,,476.16,percent of total billed charges,40% of total billed charges,554.58,1190.4,
ORTHOFIX CDL-737L,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,16500,13200.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13200,80,,10560,percent of total billed charges,80% of total billed charges,6149.55,37.27,,4919.64,percent of total billed charges,37.27% of total billed charges,6149.55,37.27,,4919.64,percent of total billed charges,37.27% of total billed charges,6149.55,37.27,,4919.64,percent of total billed charges,37.27% 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,6600,40,,5280,percent of total billed charges,40% of total billed charges,6149.55,13200,
NEUROFLEX CNCF2025,8605396,CDM,278,RC,C9352,HCPCS,Outpatient,,,6215,4972.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4972,80,,3977.6,percent of total billed charges,80% of total billed charges,2316.33,37.27,,1853.06,percent of total billed charges,37.27% of total billed charges,2316.33,37.27,,1853.06,percent of total billed charges,37.27% of total billed charges,2316.33,37.27,,1853.06,percent of total billed charges,37.27% 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,2486,40,,1988.8,percent of total billed charges,40% of total billed charges,2316.33,4972,
NEUROFLEX CNCF2525,8605396,CDM,278,RC,C9352,HCPCS,Outpatient,,,6215,4972.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4972,80,,3977.6,percent of total billed charges,80% of total billed charges,2316.33,37.27,,1853.06,percent of total billed charges,37.27% of total billed charges,2316.33,37.27,,1853.06,percent of total billed charges,37.27% of total billed charges,2316.33,37.27,,1853.06,percent of total billed charges,37.27% 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,2486,40,,1988.8,percent of total billed charges,40% of total billed charges,2316.33,4972,
FIXATN AR1593P,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2093,1674.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1674.4,80,,1339.52,percent of total billed charges,80% of total billed charges,780.06,37.27,,624.05,percent of total billed charges,37.27% of total billed charges,780.06,37.27,,624.05,percent of total billed charges,37.27% of total billed charges,780.06,37.27,,624.05,percent of total billed charges,37.27% 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,837.2,40,,669.76,percent of total billed charges,40% of total billed charges,780.06,1674.4,
SWIVELOCK AR2324KBCC,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1328,1062.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1062.4,80,,849.92,percent of total billed charges,80% of total billed charges,494.95,37.27,,395.96,percent of total billed charges,37.27% of total billed charges,494.95,37.27,,395.96,percent of total billed charges,37.27% of total billed charges,494.95,37.27,,395.96,percent of total billed charges,37.27% 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,531.2,40,,424.96,percent of total billed charges,40% of total billed charges,494.95,1062.4,
ANCHOR AR3641SP,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1299,1039.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1039.2,80,,831.36,percent of total billed charges,80% of total billed charges,484.14,37.27,,387.31,percent of total billed charges,37.27% of total billed charges,484.14,37.27,,387.31,percent of total billed charges,37.27% of total billed charges,484.14,37.27,,387.31,percent of total billed charges,37.27% 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,519.6,40,,415.68,percent of total billed charges,40% of total billed charges,484.14,1039.2,
DRILL BIT AR1870012,5801832,CDM,272,RC,,,Outpatient,,,462,369.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,369.6,80,,295.68,percent of total billed charges,80% of total billed charges,172.19,37.27,,137.75,percent of total billed charges,37.27% of total billed charges,172.19,37.27,,137.75,percent of total billed charges,37.27% of total billed charges,172.19,37.27,,137.75,percent of total billed charges,37.27% 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,184.8,40,,147.84,percent of total billed charges,40% of total billed charges,172.19,369.6,
SCREW AR1871607,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,318,254.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% 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,127.2,40,,101.76,percent of total billed charges,40% of total billed charges,118.52,254.4,
SCREW AR1871608,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,318,254.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% 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,127.2,40,,101.76,percent of total billed charges,40% of total billed charges,118.52,254.4,
SCREW AR1871609,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,318,254.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% 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,127.2,40,,101.76,percent of total billed charges,40% of total billed charges,118.52,254.4,
PLATE AR18716P03,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2296,1836.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1836.8,80,,1469.44,percent of total billed charges,80% of total billed charges,855.72,37.27,,684.58,percent of total billed charges,37.27% of total billed charges,855.72,37.27,,684.58,percent of total billed charges,37.27% of total billed charges,855.72,37.27,,684.58,percent of total billed charges,37.27% 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,918.4,40,,734.72,percent of total billed charges,40% of total billed charges,855.72,1836.8,
FREE INSULIN ASSAY,7000169,CDM,302,RC,,,Outpatient,,,109.5,87.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,87.6,80,,70.08,percent of total billed charges,80% of total billed charges,40.81,37.27,,32.65,percent of total billed charges,37.27% of total billed charges,40.81,37.27,,32.65,percent of total billed charges,37.27% of total billed charges,40.81,37.27,,32.65,percent of total billed charges,37.27% 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,43.8,40,,35.04,percent of total billed charges,40% of total billed charges,40.81,87.6,
DURAGEN PLUS DP1033,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,2615,2092.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2092,80,,1673.6,percent of total billed charges,80% of total billed charges,974.61,37.27,,779.69,percent of total billed charges,37.27% of total billed charges,974.61,37.27,,779.69,percent of total billed charges,37.27% of total billed charges,974.61,37.27,,779.69,percent of total billed charges,37.27% 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,1046,40,,836.8,percent of total billed charges,40% of total billed charges,974.61,2092,
MRI HEART W/OUT CONT,6212047,CDM,610,RC,75557,HCPCS,Outpatient,,,1250,1000.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1000,80,,800,percent of total billed charges,80% of total billed charges,465.88,37.27,,372.7,percent of total billed charges,37.27% of total billed charges,465.88,37.27,,372.7,percent of total billed charges,37.27% of total billed charges,465.88,37.27,,372.7,percent of total billed charges,37.27% of total billed charges,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,225.19,145,,,fee schedule,145% of CMS fee schedule,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,202.03,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,500,40,,400,percent of total billed charges,40% of total billed charges,202.03,1000,
MRI HEART W/WOUT CON,6212047,CDM,610,RC,75561,HCPCS,Outpatient,,,1878,1502.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1502.4,80,,1201.92,percent of total billed charges,80% of total billed charges,699.93,37.27,,559.94,percent of total billed charges,37.27% of total billed charges,699.93,37.27,,559.94,percent of total billed charges,37.27% of total billed charges,699.93,37.27,,559.94,percent of total billed charges,37.27% of total billed charges,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,321.73,145,,,fee schedule,145% of CMS fee schedule,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,317.08,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,751.2,40,,600.96,percent of total billed charges,40% of total billed charges,317.08,1502.4,
LUPRON 11.25MG ADULT,6065130,CDM,636,RC,J1950,HCPCS,Outpatient,,,14203.15,11362.52,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,11362.52,80,,9090.02,percent of total billed charges,80% of total billed charges,5293.51,37.27,,4234.81,percent of total billed charges,37.27% of total billed charges,5293.51,37.27,,4234.81,percent of total billed charges,37.27% of total billed charges,5293.51,37.27,,4234.81,percent of total billed charges,37.27% of total billed charges,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,1617.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5681.26,40,,4545.01,percent of total billed charges,40% of total billed charges,1617.65,11362.52,
PLATE 5 HOLE 4020905,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1383,1106.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1106.4,80,,885.12,percent of total billed charges,80% of total billed charges,515.44,37.27,,412.35,percent of total billed charges,37.27% of total billed charges,515.44,37.27,,412.35,percent of total billed charges,37.27% of total billed charges,515.44,37.27,,412.35,percent of total billed charges,37.27% 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,553.2,40,,442.56,percent of total billed charges,40% of total billed charges,515.44,1106.4,
REXULTI 1MG,6400014,CDM,250,RC,,,Outpatient,,,170.7,136.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,136.56,80,,109.25,percent of total billed charges,80% of total billed charges,63.62,37.27,,50.9,percent of total billed charges,37.27% of total billed charges,63.62,37.27,,50.9,percent of total billed charges,37.27% of total billed charges,63.62,37.27,,50.9,percent of total billed charges,37.27% 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,68.28,40,,54.62,percent of total billed charges,40% of total billed charges,63.62,136.56,
OMEGA DRILL 3.9MM,5801832,CDM,272,RC,,,Outpatient,,,545,436.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,436,80,,348.8,percent of total billed charges,80% of total billed charges,203.12,37.27,,162.5,percent of total billed charges,37.27% of total billed charges,203.12,37.27,,162.5,percent of total billed charges,37.27% of total billed charges,203.12,37.27,,162.5,percent of total billed charges,37.27% 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,218,40,,174.4,percent of total billed charges,40% of total billed charges,203.12,436,
FEMORAL 5517F701,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,6600,5280.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5280,80,,4224,percent of total billed charges,80% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% 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,2640,40,,2112,percent of total billed charges,40% of total billed charges,2459.82,5280,
TIB BEAR 5531G709E,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
TIBIAL COM 5536B700,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4400,3520.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3520,80,,2816,percent of total billed charges,80% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% 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,1760,40,,1408,percent of total billed charges,40% of total billed charges,1639.88,3520,
FEMORAL 5517F201,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,6600,5280.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5280,80,,4224,percent of total billed charges,80% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% 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,2640,40,,2112,percent of total billed charges,40% of total billed charges,2459.82,5280,
TIB BEAR 5531G209E,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
PATELLA 5552L299,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,1375,1100.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1100,80,,880,percent of total billed charges,80% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% 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,550,40,,440,percent of total billed charges,40% of total billed charges,512.46,1100,
GRAFTLINK 9.0X65MM,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,6098,4878.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4878.4,80,,3902.72,percent of total billed charges,80% of total billed charges,2272.72,37.27,,1818.18,percent of total billed charges,37.27% of total billed charges,2272.72,37.27,,1818.18,percent of total billed charges,37.27% of total billed charges,2272.72,37.27,,1818.18,percent of total billed charges,37.27% 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,2439.2,40,,1951.36,percent of total billed charges,40% of total billed charges,2272.72,4878.4,
STRAVIX PL PS61036,6065130,CDM,636,RC,Q4133,HCPCS,Outpatient,,,8167,6533.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6533.6,80,,5226.88,percent of total billed charges,80% of total billed charges,3043.84,37.27,,2435.07,percent of total billed charges,37.27% of total billed charges,3043.84,37.27,,2435.07,percent of total billed charges,37.27% of total billed charges,3043.84,37.27,,2435.07,percent of total billed charges,37.27% 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,3266.8,40,,2613.44,percent of total billed charges,40% of total billed charges,3043.84,6533.6,
FLIPCUTTER AR1204FF,5801832,CDM,272,RC,,,Outpatient,,,1198,958.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,958.4,80,,766.72,percent of total billed charges,80% of total billed charges,446.49,37.27,,357.19,percent of total billed charges,37.27% of total billed charges,446.49,37.27,,357.19,percent of total billed charges,37.27% of total billed charges,446.49,37.27,,357.19,percent of total billed charges,37.27% 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,479.2,40,,383.36,percent of total billed charges,40% of total billed charges,446.49,958.4,
TROPE AR1588BTBIB,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1862,1489.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1489.6,80,,1191.68,percent of total billed charges,80% of total billed charges,693.97,37.27,,555.18,percent of total billed charges,37.27% of total billed charges,693.97,37.27,,555.18,percent of total billed charges,37.27% of total billed charges,693.97,37.27,,555.18,percent of total billed charges,37.27% 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,744.8,40,,595.84,percent of total billed charges,40% of total billed charges,693.97,1489.6,
TROPE AR1588TB1,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,618,494.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,494.4,80,,395.52,percent of total billed charges,80% of total billed charges,230.33,37.27,,184.26,percent of total billed charges,37.27% of total billed charges,230.33,37.27,,184.26,percent of total billed charges,37.27% of total billed charges,230.33,37.27,,184.26,percent of total billed charges,37.27% 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,247.2,40,,197.76,percent of total billed charges,40% of total billed charges,230.33,494.4,
GUIDE WIRE 03333001,5801832,CDM,272,RC,,,Outpatient,,,435,348.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,348,80,,278.4,percent of total billed charges,80% of total billed charges,162.12,37.27,,129.7,percent of total billed charges,37.27% of total billed charges,162.12,37.27,,129.7,percent of total billed charges,37.27% of total billed charges,162.12,37.27,,129.7,percent of total billed charges,37.27% 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,174,40,,139.2,percent of total billed charges,40% of total billed charges,162.12,348,
DRILL BIT 03333101,5801832,CDM,272,RC,,,Outpatient,,,2811,2248.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2248.8,80,,1799.04,percent of total billed charges,80% of total billed charges,1047.66,37.27,,838.13,percent of total billed charges,37.27% of total billed charges,1047.66,37.27,,838.13,percent of total billed charges,37.27% of total billed charges,1047.66,37.27,,838.13,percent of total billed charges,37.27% 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,1124.4,40,,899.52,percent of total billed charges,40% of total billed charges,1047.66,2248.8,
SCREW  04333012,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2629,2103.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2103.2,80,,1682.56,percent of total billed charges,80% of total billed charges,979.83,37.27,,783.86,percent of total billed charges,37.27% of total billed charges,979.83,37.27,,783.86,percent of total billed charges,37.27% of total billed charges,979.83,37.27,,783.86,percent of total billed charges,37.27% 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,1051.6,40,,841.28,percent of total billed charges,40% of total billed charges,979.83,2103.2,
SCREW 04333014,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2629,2103.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2103.2,80,,1682.56,percent of total billed charges,80% of total billed charges,979.83,37.27,,783.86,percent of total billed charges,37.27% of total billed charges,979.83,37.27,,783.86,percent of total billed charges,37.27% of total billed charges,979.83,37.27,,783.86,percent of total billed charges,37.27% 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,1051.6,40,,841.28,percent of total billed charges,40% of total billed charges,979.83,2103.2,
REAMER AR1408LP50,5645742,CDM,270,RC,,,Outpatient,,,563,450.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,450.4,80,,360.32,percent of total billed charges,80% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% 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,225.2,40,,180.16,percent of total billed charges,40% of total billed charges,209.83,450.4,
DRILL AR1588RT2IBS,5645742,CDM,270,RC,,,Outpatient,,,2131,1704.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1704.8,80,,1363.84,percent of total billed charges,80% of total billed charges,794.22,37.27,,635.38,percent of total billed charges,37.27% of total billed charges,794.22,37.27,,635.38,percent of total billed charges,37.27% of total billed charges,794.22,37.27,,635.38,percent of total billed charges,37.27% 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,852.4,40,,681.92,percent of total billed charges,40% of total billed charges,794.22,1704.8,
ALLOGRAFT EVP841FF,8605396,CDM,278,RC,C1762,HCPCS,Outpatient,,,7838,6270.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6270.4,80,,5016.32,percent of total billed charges,80% of total billed charges,2921.22,37.27,,2336.98,percent of total billed charges,37.27% of total billed charges,2921.22,37.27,,2336.98,percent of total billed charges,37.27% of total billed charges,2921.22,37.27,,2336.98,percent of total billed charges,37.27% 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,3135.2,40,,2508.16,percent of total billed charges,40% of total billed charges,2921.22,6270.4,
BEARING 159577,8605396,CDM,278,RC,C1778,HCPCS,Outpatient,,,2750,2200.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2200,80,,1760,percent of total billed charges,80% of total billed charges,1024.93,37.27,,819.94,percent of total billed charges,37.27% of total billed charges,1024.93,37.27,,819.94,percent of total billed charges,37.27% of total billed charges,1024.93,37.27,,819.94,percent of total billed charges,37.27% 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,1100,40,,880,percent of total billed charges,40% of total billed charges,1024.93,2200,
TUBING CO2 SMK EVAC,5645742,CDM,270,RC,,,Outpatient,,,433,346.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,346.4,80,,277.12,percent of total billed charges,80% of total billed charges,161.38,37.27,,129.1,percent of total billed charges,37.27% of total billed charges,161.38,37.27,,129.1,percent of total billed charges,37.27% of total billed charges,161.38,37.27,,129.1,percent of total billed charges,37.27% 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,173.2,40,,138.56,percent of total billed charges,40% of total billed charges,161.38,346.4,
PLATE 161230,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3176,2540.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2540.8,80,,2032.64,percent of total billed charges,80% of total billed charges,1183.7,37.27,,946.96,percent of total billed charges,37.27% of total billed charges,1183.7,37.27,,946.96,percent of total billed charges,37.27% of total billed charges,1183.7,37.27,,946.96,percent of total billed charges,37.27% 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,1270.4,40,,1016.32,percent of total billed charges,40% of total billed charges,1183.7,2540.8,
SPACER 12112417S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5755,4604.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4604,80,,3683.2,percent of total billed charges,80% of total billed charges,2144.89,37.27,,1715.91,percent of total billed charges,37.27% of total billed charges,2144.89,37.27,,1715.91,percent of total billed charges,37.27% of total billed charges,2144.89,37.27,,1715.91,percent of total billed charges,37.27% 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,2302,40,,1841.6,percent of total billed charges,40% of total billed charges,2144.89,4604,
STRAVIX PL PS61024,8605396,CDM,278,RC,C1762,HCPCS,Outpatient,,,4244,3395.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3395.2,80,,2716.16,percent of total billed charges,80% of total billed charges,1581.74,37.27,,1265.39,percent of total billed charges,37.27% of total billed charges,1581.74,37.27,,1265.39,percent of total billed charges,37.27% of total billed charges,1581.74,37.27,,1265.39,percent of total billed charges,37.27% 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,1697.6,40,,1358.08,percent of total billed charges,40% of total billed charges,1581.74,3395.2,
SCREW IC2516,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,625,500.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,500,80,,400,percent of total billed charges,80% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% of total billed charges,232.94,37.27,,186.35,percent of total billed charges,37.27% 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,250,40,,200,percent of total billed charges,40% of total billed charges,232.94,500,
SCREW IH2516,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1089,871.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,871.2,80,,696.96,percent of total billed charges,80% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% of total billed charges,405.87,37.27,,324.7,percent of total billed charges,37.27% 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,435.6,40,,348.48,percent of total billed charges,40% of total billed charges,405.87,871.2,
LACOSAMIDE 100MG TAB,5880901,CDM,637,RC,,,Outpatient,,,60.55,48.44,GY,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,48.44,80,,38.75,percent of total billed charges,80% of total billed charges,22.57,37.27,,18.06,percent of total billed charges,37.27% of total billed charges,22.57,37.27,,18.06,percent of total billed charges,37.27% of total billed charges,22.57,37.27,,18.06,percent of total billed charges,37.27% 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,24.22,40,,19.38,percent of total billed charges,40% of total billed charges,22.57,48.44,
NM BRAIN PER W/VF,6001655,CDM,341,RC,78601,HCPCS,Outpatient,,,1495,1196.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1196,80,,956.8,percent of total billed charges,80% of total billed charges,557.19,37.27,,445.75,percent of total billed charges,37.27% of total billed charges,557.19,37.27,,445.75,percent of total billed charges,37.27% of total billed charges,557.19,37.27,,445.75,percent of total billed charges,37.27% of total billed charges,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,225.03,145,,,fee schedule,145% of CMS fee schedule,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,340.06,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,598,40,,478.4,percent of total billed charges,40% of total billed charges,225.03,1196,
US ELAST PARENCHYMAL,6000566,CDM,402,RC,91200,HCPCS,Outpatient,,,315,252.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252,80,,201.6,percent of total billed charges,80% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,117.4,37.27,,93.92,percent of total billed charges,37.27% of total billed charges,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,25.91,145,,,fee schedule,145% of CMS fee schedule,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,126,40,,100.8,percent of total billed charges,40% of total billed charges,25.91,252,
PFIZER COVID 30MCG,6065130,CDM,636,RC,91320,HCPCS,Outpatient,,,341,272.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% 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,136.4,40,,109.12,percent of total billed charges,40% of total billed charges,127.09,272.8,
PFIZER COVID3MCG/0.3,6065130,CDM,636,RC,91318,HCPCS,Outpatient,,,341,272.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% 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,136.4,40,,109.12,percent of total billed charges,40% of total billed charges,127.09,272.8,
PFIZER COVID 10MCG,6065130,CDM,636,RC,91319,HCPCS,Outpatient,,,341,272.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% 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,136.4,40,,109.12,percent of total billed charges,40% of total billed charges,127.09,272.8,
MODERNA COVID 50MCQ,6065130,CDM,636,RC,91322,HCPCS,Outpatient,,,341,272.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% 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,136.4,40,,109.12,percent of total billed charges,40% of total billed charges,127.09,272.8,
MODERNA COVID 25MCG,6065130,CDM,636,RC,91321,HCPCS,Outpatient,,,341,272.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,272.8,80,,218.24,percent of total billed charges,80% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% of total billed charges,127.09,37.27,,101.67,percent of total billed charges,37.27% 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,136.4,40,,109.12,percent of total billed charges,40% of total billed charges,127.09,272.8,
PLATE A465556,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4004,3203.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3203.2,80,,2562.56,percent of total billed charges,80% of total billed charges,1492.29,37.27,,1193.83,percent of total billed charges,37.27% of total billed charges,1492.29,37.27,,1193.83,percent of total billed charges,37.27% of total billed charges,1492.29,37.27,,1193.83,percent of total billed charges,37.27% 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,1601.6,40,,1281.28,percent of total billed charges,40% of total billed charges,1492.29,3203.2,
DRILL BIT A3430,5801832,CDM,272,RC,,,Outpatient,,,539,431.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,431.2,80,,344.96,percent of total billed charges,80% of total billed charges,200.89,37.27,,160.71,percent of total billed charges,37.27% of total billed charges,200.89,37.27,,160.71,percent of total billed charges,37.27% of total billed charges,200.89,37.27,,160.71,percent of total billed charges,37.27% 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,215.6,40,,172.48,percent of total billed charges,40% of total billed charges,200.89,431.2,
SCREW A5400081,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,546,436.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,436.8,80,,349.44,percent of total billed charges,80% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% 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,218.4,40,,174.72,percent of total billed charges,40% of total billed charges,203.49,436.8,
SCREW A5400101,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,546,436.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,436.8,80,,349.44,percent of total billed charges,80% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% 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,218.4,40,,174.72,percent of total billed charges,40% of total billed charges,203.49,436.8,
SCREW A5400111,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,546,436.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,436.8,80,,349.44,percent of total billed charges,80% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% 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,218.4,40,,174.72,percent of total billed charges,40% of total billed charges,203.49,436.8,
SCREW A5400131,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,546,436.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,436.8,80,,349.44,percent of total billed charges,80% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% 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,218.4,40,,174.72,percent of total billed charges,40% of total billed charges,203.49,436.8,
SCREW A5400151,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,546,436.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,436.8,80,,349.44,percent of total billed charges,80% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% of total billed charges,203.49,37.27,,162.79,percent of total billed charges,37.27% 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,218.4,40,,174.72,percent of total billed charges,40% of total billed charges,203.49,436.8,
PLATE 5425683,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3462,2769.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2769.6,80,,2215.68,percent of total billed charges,80% of total billed charges,1290.29,37.27,,1032.23,percent of total billed charges,37.27% of total billed charges,1290.29,37.27,,1032.23,percent of total billed charges,37.27% of total billed charges,1290.29,37.27,,1032.23,percent of total billed charges,37.27% 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,1384.8,40,,1107.84,percent of total billed charges,40% of total billed charges,1290.29,2769.6,
SCREW 656416,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,184,147.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.2,80,,117.76,percent of total billed charges,80% of total billed charges,68.58,37.27,,54.86,percent of total billed charges,37.27% of total billed charges,68.58,37.27,,54.86,percent of total billed charges,37.27% of total billed charges,68.58,37.27,,54.86,percent of total billed charges,37.27% 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,73.6,40,,58.88,percent of total billed charges,40% of total billed charges,68.58,147.2,
SCREW 656424,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,184,147.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,147.2,80,,117.76,percent of total billed charges,80% of total billed charges,68.58,37.27,,54.86,percent of total billed charges,37.27% of total billed charges,68.58,37.27,,54.86,percent of total billed charges,37.27% of total billed charges,68.58,37.27,,54.86,percent of total billed charges,37.27% 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,73.6,40,,58.88,percent of total billed charges,40% of total billed charges,68.58,147.2,
SCREW 656318,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,316,252.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% 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,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,117.77,252.8,
SCREW 656320,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,316,252.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% 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,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,117.77,252.8,
SCREW 656322,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,316,252.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,252.8,80,,202.24,percent of total billed charges,80% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% of total billed charges,117.77,37.27,,94.22,percent of total billed charges,37.27% 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,126.4,40,,101.12,percent of total billed charges,40% of total billed charges,117.77,252.8,
AC REPAIR KIT AR2271,5645742,CDM,270,RC,,,Outpatient,,,3248,2598.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2598.4,80,,2078.72,percent of total billed charges,80% of total billed charges,1210.53,37.27,,968.42,percent of total billed charges,37.27% of total billed charges,1210.53,37.27,,968.42,percent of total billed charges,37.27% of total billed charges,1210.53,37.27,,968.42,percent of total billed charges,37.27% 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,1299.2,40,,1039.36,percent of total billed charges,40% of total billed charges,1210.53,2598.4,
ACETAB 121732054,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4820,3856.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3856,80,,3084.8,percent of total billed charges,80% of total billed charges,1796.41,37.27,,1437.13,percent of total billed charges,37.27% of total billed charges,1796.41,37.27,,1437.13,percent of total billed charges,37.27% of total billed charges,1796.41,37.27,,1437.13,percent of total billed charges,37.27% 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,1928,40,,1542.4,percent of total billed charges,40% of total billed charges,1796.41,3856,
PINNACLE 122136154,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2453,1962.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1962.4,80,,1569.92,percent of total billed charges,80% of total billed charges,914.23,37.27,,731.38,percent of total billed charges,37.27% of total billed charges,914.23,37.27,,731.38,percent of total billed charges,37.27% of total billed charges,914.23,37.27,,731.38,percent of total billed charges,37.27% 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,981.2,40,,784.96,percent of total billed charges,40% of total billed charges,914.23,1962.4,
CERAMIC HD 136536720,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,12196,9756.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9756.8,80,,7805.44,percent of total billed charges,80% of total billed charges,4545.45,37.27,,3636.36,percent of total billed charges,37.27% of total billed charges,4545.45,37.27,,3636.36,percent of total billed charges,37.27% of total billed charges,4545.45,37.27,,3636.36,percent of total billed charges,37.27% 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,4878.4,40,,3902.72,percent of total billed charges,40% of total billed charges,4545.45,9756.8,
ADMIN RSV VACCINE,9397936,CDM,771,RC,96380,HCPCS,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.31,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34,40,,27.2,percent of total billed charges,40% of total billed charges,30.31,68,
ADMIN RSV VACCINE,9397936,CDM,771,RC,96380,HCPCS,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.31,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34,40,,27.2,percent of total billed charges,40% of total billed charges,30.31,68,
ADMIN RSV VACCINE,9397936,CDM,771,RC,96380,HCPCS,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.31,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34,40,,27.2,percent of total billed charges,40% of total billed charges,30.31,68,
ADMIN RSV VACCINE,9397936,CDM,771,RC,96380,HCPCS,Outpatient,,,85,68.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,68,80,,54.4,percent of total billed charges,80% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,31.68,37.27,,25.34,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30.31,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,34,40,,27.2,percent of total billed charges,40% of total billed charges,30.31,68,
BEARING 5531G310E,8605396,CDM,278,RC,C1778,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
PLATE 628203,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4213,3370.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3370.4,80,,2696.32,percent of total billed charges,80% of total billed charges,1570.19,37.27,,1256.15,percent of total billed charges,37.27% of total billed charges,1570.19,37.27,,1256.15,percent of total billed charges,37.27% of total billed charges,1570.19,37.27,,1256.15,percent of total billed charges,37.27% 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,1685.2,40,,1348.16,percent of total billed charges,40% of total billed charges,1570.19,3370.4,
RTNG FEMORAL 5510F50,8605396,CDM,278,RC,,,Outpatient,,,3150,2520.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2520,80,,2016,percent of total billed charges,80% of total billed charges,1174.01,37.27,,939.21,percent of total billed charges,37.27% of total billed charges,1174.01,37.27,,939.21,percent of total billed charges,37.27% of total billed charges,1174.01,37.27,,939.21,percent of total billed charges,37.27% 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,1260,40,,1008,percent of total billed charges,40% of total billed charges,1174.01,2520,
TIB BASEPLATE 5521B5,8605396,CDM,278,RC,,,Outpatient,,,2188,1750.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1750.4,80,,1400.32,percent of total billed charges,80% of total billed charges,815.47,37.27,,652.38,percent of total billed charges,37.27% of total billed charges,815.47,37.27,,652.38,percent of total billed charges,37.27% of total billed charges,815.47,37.27,,652.38,percent of total billed charges,37.27% 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,875.2,40,,700.16,percent of total billed charges,40% of total billed charges,815.47,1750.4,
AFFIRM VCF KT 658923,5801832,CDM,272,RC,,,Outpatient,,,9660,7728.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,7728,80,,6182.4,percent of total billed charges,80% of total billed charges,3600.28,37.27,,2880.22,percent of total billed charges,37.27% of total billed charges,3600.28,37.27,,2880.22,percent of total billed charges,37.27% of total billed charges,3600.28,37.27,,2880.22,percent of total billed charges,37.27% 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,3864,40,,3091.2,percent of total billed charges,40% of total billed charges,3600.28,7728,
AFFIRM ACS PK658902S,5801832,CDM,272,RC,,,Outpatient,,,2853,2282.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2282.4,80,,1825.92,percent of total billed charges,80% of total billed charges,1063.31,37.27,,850.65,percent of total billed charges,37.27% of total billed charges,1063.31,37.27,,850.65,percent of total billed charges,37.27% of total billed charges,1063.31,37.27,,850.65,percent of total billed charges,37.27% 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,1141.2,40,,912.96,percent of total billed charges,40% of total billed charges,1063.31,2282.4,
AFFIRM CMT PK 658969,5801832,CDM,272,RC,,,Outpatient,,,506,404.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,404.8,80,,323.84,percent of total billed charges,80% of total billed charges,188.59,37.27,,150.87,percent of total billed charges,37.27% of total billed charges,188.59,37.27,,150.87,percent of total billed charges,37.27% of total billed charges,188.59,37.27,,150.87,percent of total billed charges,37.27% 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,202.4,40,,161.92,percent of total billed charges,40% of total billed charges,188.59,404.8,
PLATE NAR 7H 629527,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1595,1276.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1276,80,,1020.8,percent of total billed charges,80% of total billed charges,594.46,37.27,,475.57,percent of total billed charges,37.27% of total billed charges,594.46,37.27,,475.57,percent of total billed charges,37.27% of total billed charges,594.46,37.27,,475.57,percent of total billed charges,37.27% 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,638,40,,510.4,percent of total billed charges,40% of total billed charges,594.46,1276,
PLATE NAR 5H 629505,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1595,1276.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1276,80,,1020.8,percent of total billed charges,80% of total billed charges,594.46,37.27,,475.57,percent of total billed charges,37.27% of total billed charges,594.46,37.27,,475.57,percent of total billed charges,37.27% of total billed charges,594.46,37.27,,475.57,percent of total billed charges,37.27% 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,638,40,,510.4,percent of total billed charges,40% of total billed charges,594.46,1276,
SCREW D1N35040S,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,514,411.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,411.2,80,,328.96,percent of total billed charges,80% of total billed charges,191.57,37.27,,153.26,percent of total billed charges,37.27% of total billed charges,191.57,37.27,,153.26,percent of total billed charges,37.27% of total billed charges,191.57,37.27,,153.26,percent of total billed charges,37.27% 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,205.6,40,,164.48,percent of total billed charges,40% of total billed charges,191.57,411.2,
SCREW D2N30034,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,6638,5310.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5310.4,80,,4248.32,percent of total billed charges,80% of total billed charges,2473.98,37.27,,1979.18,percent of total billed charges,37.27% of total billed charges,2473.98,37.27,,1979.18,percent of total billed charges,37.27% of total billed charges,2473.98,37.27,,1979.18,percent of total billed charges,37.27% 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,2655.2,40,,2124.16,percent of total billed charges,40% of total billed charges,2473.98,5310.4,
SCREW D2N30040,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,663,530.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,530.4,80,,424.32,percent of total billed charges,80% of total billed charges,247.1,37.27,,197.68,percent of total billed charges,37.27% of total billed charges,247.1,37.27,,197.68,percent of total billed charges,37.27% of total billed charges,247.1,37.27,,197.68,percent of total billed charges,37.27% 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,265.2,40,,212.16,percent of total billed charges,40% of total billed charges,247.1,530.4,
OMEGA SYS 3910500471,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1334,1067.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1067.2,80,,853.76,percent of total billed charges,80% of total billed charges,497.18,37.27,,397.74,percent of total billed charges,37.27% of total billed charges,497.18,37.27,,397.74,percent of total billed charges,37.27% of total billed charges,497.18,37.27,,397.74,percent of total billed charges,37.27% 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,533.6,40,,426.88,percent of total billed charges,40% of total billed charges,497.18,1067.2,
OMEGA SYS 3910500652,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1172,937.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,937.6,80,,750.08,percent of total billed charges,80% of total billed charges,436.8,37.27,,349.44,percent of total billed charges,37.27% of total billed charges,436.8,37.27,,349.44,percent of total billed charges,37.27% of total billed charges,436.8,37.27,,349.44,percent of total billed charges,37.27% 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,468.8,40,,375.04,percent of total billed charges,40% of total billed charges,436.8,937.6,
SUTURE AN 3910847120,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1373,1098.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1098.4,80,,878.72,percent of total billed charges,80% of total billed charges,511.72,37.27,,409.38,percent of total billed charges,37.27% of total billed charges,511.72,37.27,,409.38,percent of total billed charges,37.27% of total billed charges,511.72,37.27,,409.38,percent of total billed charges,37.27% 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,549.2,40,,439.36,percent of total billed charges,40% of total billed charges,511.72,1098.4,
MENISCAL BERNG 15958,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2750,2200.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2200,80,,1760,percent of total billed charges,80% of total billed charges,1024.93,37.27,,819.94,percent of total billed charges,37.27% of total billed charges,1024.93,37.27,,819.94,percent of total billed charges,37.27% of total billed charges,1024.93,37.27,,819.94,percent of total billed charges,37.27% 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,1100,40,,880,percent of total billed charges,40% of total billed charges,1024.93,2200,
OMEGA TAP,5801832,CDM,272,RC,,,Outpatient,,,690,552.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,552,80,,441.6,percent of total billed charges,80% of total billed charges,257.16,37.27,,205.73,percent of total billed charges,37.27% of total billed charges,257.16,37.27,,205.73,percent of total billed charges,37.27% of total billed charges,257.16,37.27,,205.73,percent of total billed charges,37.27% 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,276,40,,220.8,percent of total billed charges,40% of total billed charges,257.16,552,
IMPL BICEPS AR2260BC,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3176,2540.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2540.8,80,,2032.64,percent of total billed charges,80% of total billed charges,1183.7,37.27,,946.96,percent of total billed charges,37.27% of total billed charges,1183.7,37.27,,946.96,percent of total billed charges,37.27% of total billed charges,1183.7,37.27,,946.96,percent of total billed charges,37.27% 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,1270.4,40,,1016.32,percent of total billed charges,40% of total billed charges,1183.7,2540.8,
SCREW QFX AR874046PT,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,476,380.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380.8,80,,304.64,percent of total billed charges,80% of total billed charges,177.41,37.27,,141.93,percent of total billed charges,37.27% of total billed charges,177.41,37.27,,141.93,percent of total billed charges,37.27% of total billed charges,177.41,37.27,,141.93,percent of total billed charges,37.27% 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,190.4,40,,152.32,percent of total billed charges,40% of total billed charges,177.41,380.8,
TROPE KLESS AR8925T,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4317,3453.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3453.6,80,,2762.88,percent of total billed charges,80% of total billed charges,1608.95,37.27,,1287.16,percent of total billed charges,37.27% of total billed charges,1608.95,37.27,,1287.16,percent of total billed charges,37.27% of total billed charges,1608.95,37.27,,1287.16,percent of total billed charges,37.27% 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,1726.8,40,,1381.44,percent of total billed charges,40% of total billed charges,1608.95,3453.6,
SCREW LOPRO AR893316,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,318,254.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% 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,127.2,40,,101.76,percent of total billed charges,40% of total billed charges,118.52,254.4,
SCREW KLK AR8933VCL2,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
SCREW LOPRO AR893512,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,173,138.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% 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,69.2,40,,55.36,percent of total billed charges,40% of total billed charges,64.48,138.4,
SCREW LOPRO AR894016,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,173,138.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,138.4,80,,110.72,percent of total billed charges,80% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% of total billed charges,64.48,37.27,,51.58,percent of total billed charges,37.27% 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,69.2,40,,55.36,percent of total billed charges,40% of total billed charges,64.48,138.4,
RATCHET HND AR8950RH,5801832,CDM,272,RC,,,Outpatient,,,2873,2298.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2298.4,80,,1838.72,percent of total billed charges,80% of total billed charges,1070.77,37.27,,856.62,percent of total billed charges,37.27% of total billed charges,1070.77,37.27,,856.62,percent of total billed charges,37.27% of total billed charges,1070.77,37.27,,856.62,percent of total billed charges,37.27% 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,1149.2,40,,919.36,percent of total billed charges,40% of total billed charges,1070.77,2298.4,
PLATE FIB AR9943BR08,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2440,1952.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1952,80,,1561.6,percent of total billed charges,80% of total billed charges,909.39,37.27,,727.51,percent of total billed charges,37.27% of total billed charges,909.39,37.27,,727.51,percent of total billed charges,37.27% of total billed charges,909.39,37.27,,727.51,percent of total billed charges,37.27% 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,976,40,,780.8,percent of total billed charges,40% of total billed charges,909.39,1952,
SCREW QFX AR874060PT,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,476,380.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380.8,80,,304.64,percent of total billed charges,80% of total billed charges,177.41,37.27,,141.93,percent of total billed charges,37.27% of total billed charges,177.41,37.27,,141.93,percent of total billed charges,37.27% of total billed charges,177.41,37.27,,141.93,percent of total billed charges,37.27% 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,190.4,40,,152.32,percent of total billed charges,40% of total billed charges,177.41,380.8,
SCREW LOPRO AR893318,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,318,254.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% 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,127.2,40,,101.76,percent of total billed charges,40% of total billed charges,118.52,254.4,
SCREW LOPRO AR893320,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,318,254.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% 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,127.2,40,,101.76,percent of total billed charges,40% of total billed charges,118.52,254.4,
SCREW KLK AR8933VCL2,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
SCREW KLCK AR8935CL1,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
PLATE FIB AR9943BL06,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2238,1790.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1790.4,80,,1432.32,percent of total billed charges,80% of total billed charges,834.1,37.27,,667.28,percent of total billed charges,37.27% of total billed charges,834.1,37.27,,667.28,percent of total billed charges,37.27% of total billed charges,834.1,37.27,,667.28,percent of total billed charges,37.27% 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,895.2,40,,716.16,percent of total billed charges,40% of total billed charges,834.1,1790.4,
PLATE 7 HOLE626677,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1136,908.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,908.8,80,,727.04,percent of total billed charges,80% of total billed charges,423.39,37.27,,338.71,percent of total billed charges,37.27% of total billed charges,423.39,37.27,,338.71,percent of total billed charges,37.27% of total billed charges,423.39,37.27,,338.71,percent of total billed charges,37.27% 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,454.4,40,,363.52,percent of total billed charges,40% of total billed charges,423.39,908.8,
BB-TAK THRD AR13226T,5645742,CDM,270,RC,,,Outpatient,,,156,124.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,124.8,80,,99.84,percent of total billed charges,80% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% of total billed charges,58.14,37.27,,46.51,percent of total billed charges,37.27% 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,62.4,40,,49.92,percent of total billed charges,40% of total billed charges,58.14,124.8,
TROPE BUTT AR8959TDS,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,7341,5872.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5872.8,80,,4698.24,percent of total billed charges,80% of total billed charges,2735.99,37.27,,2188.79,percent of total billed charges,37.27% of total billed charges,2735.99,37.27,,2188.79,percent of total billed charges,37.27% of total billed charges,2735.99,37.27,,2188.79,percent of total billed charges,37.27% 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,2936.4,40,,2349.12,percent of total billed charges,40% of total billed charges,2735.99,5872.8,
PLATE LOK AR9943BR06,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1425,1140.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1140,80,,912,percent of total billed charges,80% of total billed charges,531.1,37.27,,424.88,percent of total billed charges,37.27% of total billed charges,531.1,37.27,,424.88,percent of total billed charges,37.27% of total billed charges,531.1,37.27,,424.88,percent of total billed charges,37.27% 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,570,40,,456,percent of total billed charges,40% of total billed charges,531.1,1140,
SCREW AR893322,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,318,254.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,254.4,80,,203.52,percent of total billed charges,80% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% of total billed charges,118.52,37.27,,94.82,percent of total billed charges,37.27% 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,127.2,40,,101.76,percent of total billed charges,40% of total billed charges,118.52,254.4,
SCREW AR8933VCL12,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
SCREW AR8933VCL14,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
SCREW AR8933VCL16,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
SCREW AR8935CL,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
CT CALCIUM SCORE WO,6010052,CDM,350,RC,75571,HCPCS,Outpatient,,,145,116.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,116,80,,92.8,percent of total billed charges,80% of total billed charges,54.04,37.27,,43.23,percent of total billed charges,37.27% of total billed charges,54.04,37.27,,43.23,percent of total billed charges,37.27% of total billed charges,54.04,37.27,,43.23,percent of total billed charges,37.27% of total billed charges,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,95.8,145,,,fee schedule,145% of CMS fee schedule,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,74.92,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,58,40,,46.4,percent of total billed charges,40% of total billed charges,54.04,116,
PLATE 3 HOLE 4020903,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2203,1762.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1762.4,80,,1409.92,percent of total billed charges,80% of total billed charges,821.06,37.27,,656.85,percent of total billed charges,37.27% of total billed charges,821.06,37.27,,656.85,percent of total billed charges,37.27% of total billed charges,821.06,37.27,,656.85,percent of total billed charges,37.27% 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,881.2,40,,704.96,percent of total billed charges,40% of total billed charges,821.06,1762.4,
PINNING SYS 25440011,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1112,889.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,889.6,80,,711.68,percent of total billed charges,80% of total billed charges,414.44,37.27,,331.55,percent of total billed charges,37.27% of total billed charges,414.44,37.27,,331.55,percent of total billed charges,37.27% of total billed charges,414.44,37.27,,331.55,percent of total billed charges,37.27% 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,444.8,40,,355.84,percent of total billed charges,40% of total billed charges,414.44,889.6,
TIB INSERT 151630607,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3326,2660.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2660.8,80,,2128.64,percent of total billed charges,80% of total billed charges,1239.6,37.27,,991.68,percent of total billed charges,37.27% of total billed charges,1239.6,37.27,,991.68,percent of total billed charges,37.27% of total billed charges,1239.6,37.27,,991.68,percent of total billed charges,37.27% 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,1330.4,40,,1064.32,percent of total billed charges,40% of total billed charges,1239.6,2660.8,
PATELLA MED 15182003,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1083,866.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,866.4,80,,693.12,percent of total billed charges,80% of total billed charges,403.63,37.27,,322.9,percent of total billed charges,37.27% of total billed charges,403.63,37.27,,322.9,percent of total billed charges,37.27% of total billed charges,403.63,37.27,,322.9,percent of total billed charges,37.27% 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,433.2,40,,346.56,percent of total billed charges,40% of total billed charges,403.63,866.4,
KNEE SYS 150680006,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3139,2511.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2511.2,80,,2008.96,percent of total billed charges,80% of total billed charges,1169.91,37.27,,935.93,percent of total billed charges,37.27% of total billed charges,1169.91,37.27,,935.93,percent of total billed charges,37.27% of total billed charges,1169.91,37.27,,935.93,percent of total billed charges,37.27% 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,1255.6,40,,1004.48,percent of total billed charges,40% of total billed charges,1169.91,2511.2,
FEM CRC RTN 15040110,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5815,4652.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4652,80,,3721.6,percent of total billed charges,80% of total billed charges,2167.25,37.27,,1733.8,percent of total billed charges,37.27% of total billed charges,2167.25,37.27,,1733.8,percent of total billed charges,37.27% of total billed charges,2167.25,37.27,,1733.8,percent of total billed charges,37.27% 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,2326,40,,1860.8,percent of total billed charges,40% of total billed charges,2167.25,4652,
CORETRAK SP XPCK1002,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,10035,8028.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8028,80,,6422.4,percent of total billed charges,80% of total billed charges,3740.04,37.27,,2992.03,percent of total billed charges,37.27% of total billed charges,3740.04,37.27,,2992.03,percent of total billed charges,37.27% of total billed charges,3740.04,37.27,,2992.03,percent of total billed charges,37.27% 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,4014,40,,3211.2,percent of total billed charges,40% of total billed charges,3740.04,8028,
CORETRAK SP XPCK1303,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,10035,8028.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8028,80,,6422.4,percent of total billed charges,80% of total billed charges,3740.04,37.27,,2992.03,percent of total billed charges,37.27% of total billed charges,3740.04,37.27,,2992.03,percent of total billed charges,37.27% of total billed charges,3740.04,37.27,,2992.03,percent of total billed charges,37.27% 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,4014,40,,3211.2,percent of total billed charges,40% of total billed charges,3740.04,8028,
CREO AMP 10674645,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1733,1386.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1386.4,80,,1109.12,percent of total billed charges,80% of total billed charges,645.89,37.27,,516.71,percent of total billed charges,37.27% of total billed charges,645.89,37.27,,516.71,percent of total billed charges,37.27% of total billed charges,645.89,37.27,,516.71,percent of total billed charges,37.27% 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,693.2,40,,554.56,percent of total billed charges,40% of total billed charges,645.89,1386.4,
ROD CURVED 132150,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3000,2400.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2400,80,,1920,percent of total billed charges,80% of total billed charges,1118.1,37.27,,894.48,percent of total billed charges,37.27% of total billed charges,1118.1,37.27,,894.48,percent of total billed charges,37.27% of total billed charges,1118.1,37.27,,894.48,percent of total billed charges,37.27% 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,1200,40,,960,percent of total billed charges,40% of total billed charges,1118.1,2400,
PLATE 5425673,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3407,2725.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2725.6,80,,2180.48,percent of total billed charges,80% of total billed charges,1269.79,37.27,,1015.83,percent of total billed charges,37.27% of total billed charges,1269.79,37.27,,1015.83,percent of total billed charges,37.27% of total billed charges,1269.79,37.27,,1015.83,percent of total billed charges,37.27% 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,1362.8,40,,1090.24,percent of total billed charges,40% of total billed charges,1269.79,2725.6,
SCREW 656414,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3336,2668.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2668.8,80,,2135.04,percent of total billed charges,80% of total billed charges,1243.33,37.27,,994.66,percent of total billed charges,37.27% of total billed charges,1243.33,37.27,,994.66,percent of total billed charges,37.27% of total billed charges,1243.33,37.27,,994.66,percent of total billed charges,37.27% 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,1334.4,40,,1067.52,percent of total billed charges,40% of total billed charges,1243.33,2668.8,
QUADLINK AR1288QIS10,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,6280,5024.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5024,80,,4019.2,percent of total billed charges,80% of total billed charges,2340.56,37.27,,1872.45,percent of total billed charges,37.27% of total billed charges,2340.56,37.27,,1872.45,percent of total billed charges,37.27% of total billed charges,2340.56,37.27,,1872.45,percent of total billed charges,37.27% 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,2512,40,,2009.6,percent of total billed charges,40% of total billed charges,2340.56,5024,
TIB TRA R MED 154776,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,4400,3520.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3520,80,,2816,percent of total billed charges,80% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% 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,1760,40,,1408,percent of total billed charges,40% of total billed charges,1639.88,3520,
MENISC BEARING 15958,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2750,2200.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2200,80,,1760,percent of total billed charges,80% of total billed charges,1024.93,37.27,,819.94,percent of total billed charges,37.27% of total billed charges,1024.93,37.27,,819.94,percent of total billed charges,37.27% of total billed charges,1024.93,37.27,,819.94,percent of total billed charges,37.27% 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,1100,40,,880,percent of total billed charges,40% of total billed charges,1024.93,2200,
FEM TWIN PEG 161470,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,6600,5280.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5280,80,,4224,percent of total billed charges,80% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% 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,2640,40,,2112,percent of total billed charges,40% of total billed charges,2459.82,5280,
ACETAB SHLL 12173204,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4820,3856.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3856,80,,3084.8,percent of total billed charges,80% of total billed charges,1796.41,37.27,,1437.13,percent of total billed charges,37.27% of total billed charges,1796.41,37.27,,1437.13,percent of total billed charges,37.27% of total billed charges,1796.41,37.27,,1437.13,percent of total billed charges,37.27% 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,1928,40,,1542.4,percent of total billed charges,40% of total billed charges,1796.41,3856,
FEM STEM 157002100,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,5272,4217.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4217.6,80,,3374.08,percent of total billed charges,80% of total billed charges,1964.87,37.27,,1571.9,percent of total billed charges,37.27% of total billed charges,1964.87,37.27,,1571.9,percent of total billed charges,37.27% of total billed charges,1964.87,37.27,,1571.9,percent of total billed charges,37.27% 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,2108.8,40,,1687.04,percent of total billed charges,40% of total billed charges,1964.87,4217.6,
FEM HEAD 136532730,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,7333,5866.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5866.4,80,,4693.12,percent of total billed charges,80% of total billed charges,2733.01,37.27,,2186.41,percent of total billed charges,37.27% of total billed charges,2733.01,37.27,,2186.41,percent of total billed charges,37.27% of total billed charges,2733.01,37.27,,2186.41,percent of total billed charges,37.27% 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,2933.2,40,,2346.56,percent of total billed charges,40% of total billed charges,2733.01,5866.4,
ACETAB LINR 12213214,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,1561,1248.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1248.8,80,,999.04,percent of total billed charges,80% of total billed charges,581.78,37.27,,465.42,percent of total billed charges,37.27% of total billed charges,581.78,37.27,,465.42,percent of total billed charges,37.27% of total billed charges,581.78,37.27,,465.42,percent of total billed charges,37.27% 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,624.4,40,,499.52,percent of total billed charges,40% of total billed charges,581.78,1248.8,
BLADE RECP 027709627,5801832,CDM,272,RC,,,Outpatient,,,44,35.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,35.2,80,,28.16,percent of total billed charges,80% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% of total billed charges,16.4,37.27,,13.12,percent of total billed charges,37.27% 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,17.6,40,,14.08,percent of total billed charges,40% of total billed charges,16.4,35.2,
TIB BEAR 5531G311E,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,1925,1540.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1540,80,,1232,percent of total billed charges,80% of total billed charges,717.45,37.27,,573.96,percent of total billed charges,37.27% of total billed charges,717.45,37.27,,573.96,percent of total billed charges,37.27% of total billed charges,717.45,37.27,,573.96,percent of total billed charges,37.27% 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,770,40,,616,percent of total billed charges,40% of total billed charges,717.45,1540,
QUTENZA PATCH,6065130,CDM,636,RC,,,Outpatient,,,3088.3,2470.64,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2470.64,80,,1976.51,percent of total billed charges,80% of total billed charges,1151.01,37.27,,920.81,percent of total billed charges,37.27% of total billed charges,1151.01,37.27,,920.81,percent of total billed charges,37.27% of total billed charges,1151.01,37.27,,920.81,percent of total billed charges,37.27% 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,1235.32,40,,988.26,percent of total billed charges,40% of total billed charges,1151.01,2470.64,
STELARA 90MG INJ SC,6065130,CDM,636,RC,J3357,HCPCS,Outpatient,,,76846.25,61477.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,61477,80,,49181.6,percent of total billed charges,80% of total billed charges,28640.6,37.27,,22912.48,percent of total billed charges,37.27% of total billed charges,28640.6,37.27,,22912.48,percent of total billed charges,37.27% of total billed charges,28640.6,37.27,,22912.48,percent of total billed charges,37.27% of total billed charges,159.91,100,,,fee schedule,100% of APC rate,159.91,100,,,fee schedule,100% of APC rate,159.91,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,159.91,100,,,fee schedule,100% of APC rate,159.91,100,,,fee schedule,100% of APC rate,159.91,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,30738.5,40,,24590.8,percent of total billed charges,40% of total billed charges,159.91,61477,
GLEN BPLATE 10000589,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5638,4510.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4510.4,80,,3608.32,percent of total billed charges,80% of total billed charges,2101.28,37.27,,1681.02,percent of total billed charges,37.27% of total billed charges,2101.28,37.27,,1681.02,percent of total billed charges,37.27% of total billed charges,2101.28,37.27,,1681.02,percent of total billed charges,37.27% 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,2255.2,40,,1804.16,percent of total billed charges,40% of total billed charges,2101.28,4510.4,
PIN THREAD 406669,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,591,472.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,472.8,80,,378.24,percent of total billed charges,80% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% of total billed charges,220.27,37.27,,176.22,percent of total billed charges,37.27% 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,236.4,40,,189.12,percent of total billed charges,40% of total billed charges,220.27,472.8,
SCREW LOCKING 180551,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,275,220.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
SHOULDER STEM 113614,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,10450,8360.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8360,80,,6688,percent of total billed charges,80% of total billed charges,3894.72,37.27,,3115.78,percent of total billed charges,37.27% of total billed charges,3894.72,37.27,,3115.78,percent of total billed charges,37.27% of total billed charges,3894.72,37.27,,3115.78,percent of total billed charges,37.27% 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,4180,40,,3344,percent of total billed charges,40% of total billed charges,3894.72,8360,
HUMRL TRAY 110031399,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,457,365.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,365.6,80,,292.48,percent of total billed charges,80% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% of total billed charges,170.32,37.27,,136.26,percent of total billed charges,37.27% 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,182.8,40,,146.24,percent of total billed charges,40% of total billed charges,170.32,365.6,
ACHILLES AR9929BC-CP,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,7942,6353.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6353.6,80,,5082.88,percent of total billed charges,80% of total billed charges,2959.98,37.27,,2367.98,percent of total billed charges,37.27% of total billed charges,2959.98,37.27,,2367.98,percent of total billed charges,37.27% of total billed charges,2959.98,37.27,,2367.98,percent of total billed charges,37.27% 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,3176.8,40,,2541.44,percent of total billed charges,40% of total billed charges,2959.98,6353.6,
US OB TRANS ABD <14,6000566,CDM,402,RC,76801,HCPCS,Outpatient,,,720,576.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,576,80,,460.8,percent of total billed charges,80% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,268.34,37.27,,214.67,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.18,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,288,40,,230.4,percent of total billed charges,40% of total billed charges,90.18,576,
ACELLODERM AD0900407,8605396,CDM,278,RC,,,Outpatient,,,7000,5600.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5600,80,,4480,percent of total billed charges,80% of total billed charges,2608.9,37.27,,2087.12,percent of total billed charges,37.27% of total billed charges,2608.9,37.27,,2087.12,percent of total billed charges,37.27% of total billed charges,2608.9,37.27,,2087.12,percent of total billed charges,37.27% 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,2800,40,,2240,percent of total billed charges,40% of total billed charges,2608.9,5600,
SCREW 35MM 115397,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
PUL 6 MIN WALK TEST,7441215,CDM,460,RC,94618,HCPCS,Outpatient,,,350,280.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,80,,224,percent of total billed charges,80% of total billed charges,130.45,37.27,,104.36,percent of total billed charges,37.27% of total billed charges,130.45,37.27,,104.36,percent of total billed charges,37.27% of total billed charges,130.45,37.27,,104.36,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,15.76,145,,,fee schedule,145% of CMS fee schedule,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140,40,,112,percent of total billed charges,40% of total billed charges,15.76,280,
MONTEGRITY 2MG,5880901,CDM,637,RC,,,Outpatient,,,72.35,57.88,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,57.88,80,,46.3,percent of total billed charges,80% of total billed charges,26.96,37.27,,21.57,percent of total billed charges,37.27% of total billed charges,26.96,37.27,,21.57,percent of total billed charges,37.27% of total billed charges,26.96,37.27,,21.57,percent of total billed charges,37.27% 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,28.94,40,,23.15,percent of total billed charges,40% of total billed charges,26.96,57.88,
PROHANCE 10ML,6000905,CDM,255,RC,A9579,HCPCS,Outpatient,,,199,159.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% 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,79.6,40,,63.68,percent of total billed charges,40% of total billed charges,74.17,159.2,
PROHANCE 15ML,6000905,CDM,255,RC,A9579,HCPCS,Outpatient,,,225,180.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,180,80,,144,percent of total billed charges,80% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% of total billed charges,83.86,37.27,,67.09,percent of total billed charges,37.27% 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,90,40,,72,percent of total billed charges,40% of total billed charges,83.86,180,
PROHANCE 20ML,6000905,CDM,255,RC,A9579,HCPCS,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
OMNIPAQUE 350MG/75ML,6000905,CDM,255,RC,Q9967,HCPCS,Outpatient,,,199,159.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% 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,79.6,40,,63.68,percent of total billed charges,40% of total billed charges,74.17,159.2,
OMNIPAQUE 350MG/100M,6000905,CDM,255,RC,Q9967,HCPCS,Outpatient,,,275,220.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
VERSAGRAFT VRG351,8605396,CDM,278,RC,C1762,HCPCS,Outpatient,,,2328,1862.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1862.4,80,,1489.92,percent of total billed charges,80% of total billed charges,867.65,37.27,,694.12,percent of total billed charges,37.27% of total billed charges,867.65,37.27,,694.12,percent of total billed charges,37.27% of total billed charges,867.65,37.27,,694.12,percent of total billed charges,37.27% 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,931.2,40,,744.96,percent of total billed charges,40% of total billed charges,867.65,1862.4,
IMP YS AR1360FTBC,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,5761,4608.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,4608.8,80,,3687.04,percent of total billed charges,80% of total billed charges,2147.12,37.27,,1717.7,percent of total billed charges,37.27% of total billed charges,2147.12,37.27,,1717.7,percent of total billed charges,37.27% of total billed charges,2147.12,37.27,,1717.7,percent of total billed charges,37.27% 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,2304.4,40,,1843.52,percent of total billed charges,40% of total billed charges,2147.12,4608.8,
SCREW AR420C07,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
KWIRE 705355,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,237,189.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,189.6,80,,151.68,percent of total billed charges,80% of total billed charges,88.33,37.27,,70.66,percent of total billed charges,37.27% of total billed charges,88.33,37.27,,70.66,percent of total billed charges,37.27% of total billed charges,88.33,37.27,,70.66,percent of total billed charges,37.27% 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,94.8,40,,75.84,percent of total billed charges,40% of total billed charges,88.33,189.6,
DRILL BIT 705357,5801832,CDM,272,RC,,,Outpatient,,,561,448.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,448.8,80,,359.04,percent of total billed charges,80% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% of total billed charges,209.08,37.27,,167.26,percent of total billed charges,37.27% 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,224.4,40,,179.52,percent of total billed charges,40% of total billed charges,209.08,448.8,
SCREW 4.0X55 663055,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3110,2488.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2488,80,,1990.4,percent of total billed charges,80% of total billed charges,1159.1,37.27,,927.28,percent of total billed charges,37.27% of total billed charges,1159.1,37.27,,927.28,percent of total billed charges,37.27% of total billed charges,1159.1,37.27,,927.28,percent of total billed charges,37.27% 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,1244,40,,995.2,percent of total billed charges,40% of total billed charges,1159.1,2488,
SCREW 4.0X50 663050,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3110,2488.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2488,80,,1990.4,percent of total billed charges,80% of total billed charges,1159.1,37.27,,927.28,percent of total billed charges,37.27% of total billed charges,1159.1,37.27,,927.28,percent of total billed charges,37.27% of total billed charges,1159.1,37.27,,927.28,percent of total billed charges,37.27% 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,1244,40,,995.2,percent of total billed charges,40% of total billed charges,1159.1,2488,
SCREW AR874055PTS,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,476,380.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380.8,80,,304.64,percent of total billed charges,80% of total billed charges,177.41,37.27,,141.93,percent of total billed charges,37.27% of total billed charges,177.41,37.27,,141.93,percent of total billed charges,37.27% of total billed charges,177.41,37.27,,141.93,percent of total billed charges,37.27% 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,190.4,40,,152.32,percent of total billed charges,40% of total billed charges,177.41,380.8,
WASHER AR8740W,8605396,CDM,278,RC,,,Outpatient,,,101,80.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% 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,40.4,40,,32.32,percent of total billed charges,40% of total billed charges,37.64,80.8,
SCREW AR8933VCL18,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,852,681.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,681.6,80,,545.28,percent of total billed charges,80% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% of total billed charges,317.54,37.27,,254.03,percent of total billed charges,37.27% 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,340.8,40,,272.64,percent of total billed charges,40% of total billed charges,317.54,681.6,
PLATE AR9943BR05,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2021,1616.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1616.8,80,,1293.44,percent of total billed charges,80% of total billed charges,753.23,37.27,,602.58,percent of total billed charges,37.27% of total billed charges,753.23,37.27,,602.58,percent of total billed charges,37.27% of total billed charges,753.23,37.27,,602.58,percent of total billed charges,37.27% 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,808.4,40,,646.72,percent of total billed charges,40% of total billed charges,753.23,1616.8,
TIB INSERT 5531G510E,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3024,2419.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2419.2,80,,1935.36,percent of total billed charges,80% of total billed charges,1127.04,37.27,,901.63,percent of total billed charges,37.27% of total billed charges,1127.04,37.27,,901.63,percent of total billed charges,37.27% of total billed charges,1127.04,37.27,,901.63,percent of total billed charges,37.27% 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,1209.6,40,,967.68,percent of total billed charges,40% of total billed charges,1127.04,2419.2,
CEMENTED STEM 5560S1,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3047,2437.60,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2437.6,80,,1950.08,percent of total billed charges,80% of total billed charges,1135.62,37.27,,908.5,percent of total billed charges,37.27% of total billed charges,1135.62,37.27,,908.5,percent of total billed charges,37.27% of total billed charges,1135.62,37.27,,908.5,percent of total billed charges,37.27% 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,1218.8,40,,975.04,percent of total billed charges,40% of total billed charges,1135.62,2437.6,
PATELLA 5552L401,8605396,CDM,278,RC,L8699,HCPCS,Outpatient,,,1375,1100.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1100,80,,880,percent of total billed charges,80% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% of total billed charges,512.46,37.27,,409.97,percent of total billed charges,37.27% 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,550,40,,440,percent of total billed charges,40% of total billed charges,512.46,1100,
FEMORAL 5517F801,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,6600,5280.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,5280,80,,4224,percent of total billed charges,80% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% of total billed charges,2459.82,37.27,,1967.86,percent of total billed charges,37.27% 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,2640,40,,2112,percent of total billed charges,40% of total billed charges,2459.82,5280,
TIBIAL COMP 5536B800,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4400,3520.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3520,80,,2816,percent of total billed charges,80% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% of total billed charges,1639.88,37.27,,1311.9,percent of total billed charges,37.27% 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,1760,40,,1408,percent of total billed charges,40% of total billed charges,1639.88,3520,
TIB BEAR 5531G810E,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,3025,2420.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2420,80,,1936,percent of total billed charges,80% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% of total billed charges,1127.42,37.27,,901.94,percent of total billed charges,37.27% 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,1210,40,,968,percent of total billed charges,40% of total billed charges,1127.42,2420,
VANCOMYCIN ORAL SOL,,,630,RC,,,Outpatient,,,901.75,721.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,721.4,80,,577.12,percent of total billed charges,80% of total billed charges,336.08,37.27,,268.86,percent of total billed charges,37.27% of total billed charges,336.08,37.27,,268.86,percent of total billed charges,37.27% of total billed charges,336.08,37.27,,268.86,percent of total billed charges,37.27% 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,360.7,40,,288.56,percent of total billed charges,40% of total billed charges,336.08,721.4,
FIBERSTITCH AR4580,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1011,808.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,808.8,80,,647.04,percent of total billed charges,80% of total billed charges,376.8,37.27,,301.44,percent of total billed charges,37.27% of total billed charges,376.8,37.27,,301.44,percent of total billed charges,37.27% of total billed charges,376.8,37.27,,301.44,percent of total billed charges,37.27% 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,404.4,40,,323.52,percent of total billed charges,40% of total billed charges,376.8,808.8,
FIBERSTITCH AR458024,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1010,808.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,808,80,,646.4,percent of total billed charges,80% of total billed charges,376.43,37.27,,301.14,percent of total billed charges,37.27% of total billed charges,376.43,37.27,,301.14,percent of total billed charges,37.27% of total billed charges,376.43,37.27,,301.14,percent of total billed charges,37.27% 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,404,40,,323.2,percent of total billed charges,40% of total billed charges,376.43,808,
DELTA RESEARCH EGD,8602000,CDM,750,RC,SURG,HCPCS,Outpatient,,,1200,960.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,80,,768,percent of total billed charges,80% of total billed charges,447.24,37.27,,357.79,percent of total billed charges,37.27% of total billed charges,447.24,37.27,,357.79,percent of total billed charges,37.27% of total billed charges,447.24,37.27,,357.79,percent of total billed charges,37.27% 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,480,40,,384,percent of total billed charges,40% of total billed charges,447.24,960,
DELTA RESEARCH COLON,8602000,CDM,750,RC,SURG,HCPCS,Outpatient,,,1200,960.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,80,,768,percent of total billed charges,80% of total billed charges,447.24,37.27,,357.79,percent of total billed charges,37.27% of total billed charges,447.24,37.27,,357.79,percent of total billed charges,37.27% of total billed charges,447.24,37.27,,357.79,percent of total billed charges,37.27% 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,480,40,,384,percent of total billed charges,40% of total billed charges,447.24,960,
DELTA RES ADDTL PROC,8602000,CDM,750,RC,SURG,HCPCS,Outpatient,,,500,400.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,400,80,,320,percent of total billed charges,80% of total billed charges,186.35,37.27,,149.08,percent of total billed charges,37.27% of total billed charges,186.35,37.27,,149.08,percent of total billed charges,37.27% of total billed charges,186.35,37.27,,149.08,percent of total billed charges,37.27% 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,200,40,,160,percent of total billed charges,40% of total billed charges,186.35,400,
ISOVUE 370 75ML,6000905,CDM,255,RC,Q9967,HCPCS,Outpatient,,,199,159.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,159.2,80,,127.36,percent of total billed charges,80% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% of total billed charges,74.17,37.27,,59.34,percent of total billed charges,37.27% 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,79.6,40,,63.68,percent of total billed charges,40% of total billed charges,74.17,159.2,
ISOVUE 370 100ML,6000905,CDM,255,RC,Q9967,HCPCS,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
TEL MIDLINE INSERTIO,5612346,CDM,761,RC,36410,HCPCS,Outpatient,,,2400,1920.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1920,80,,1536,percent of total billed charges,80% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.75,145,,,fee schedule,145% of CMS fee schedule,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,40,,768,percent of total billed charges,40% of total billed charges,12.75,1920,
TEL PICC STERILE TEC,5612346,CDM,761,RC,36569,HCPCS,Outpatient,,,2700,2160.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2160,80,,1728,percent of total billed charges,80% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,133.08,145,,,fee schedule,145% of CMS fee schedule,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1080,40,,864,percent of total billed charges,40% of total billed charges,133.08,2160,
US LIVER ELASTROGRAP,6000566,CDM,402,RC,76981,HCPCS,Outpatient,,,675,540.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540,80,,432,percent of total billed charges,80% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,96.95,145,,,fee schedule,145% of CMS fee schedule,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,270,40,,216,percent of total billed charges,40% of total billed charges,90.64,540,
ENDOBLADE AR8855DS,5801832,CDM,272,RC,,,Outpatient,,,2584,2067.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2067.2,80,,1653.76,percent of total billed charges,80% of total billed charges,963.06,37.27,,770.45,percent of total billed charges,37.27% of total billed charges,963.06,37.27,,770.45,percent of total billed charges,37.27% of total billed charges,963.06,37.27,,770.45,percent of total billed charges,37.27% 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,1033.6,40,,826.88,percent of total billed charges,40% of total billed charges,963.06,2067.2,
DRILL AR1288RTT2IBS,5801832,CDM,272,RC,,,Outpatient,,,2614,2091.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2091.2,80,,1672.96,percent of total billed charges,80% of total billed charges,974.24,37.27,,779.39,percent of total billed charges,37.27% of total billed charges,974.24,37.27,,779.39,percent of total billed charges,37.27% of total billed charges,974.24,37.27,,779.39,percent of total billed charges,37.27% 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,1045.6,40,,836.48,percent of total billed charges,40% of total billed charges,974.24,2091.2,
SCREW 2.7X16 AR88271,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,476,380.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380.8,80,,304.64,percent of total billed charges,80% of total billed charges,177.41,37.27,,141.93,percent of total billed charges,37.27% of total billed charges,177.41,37.27,,141.93,percent of total billed charges,37.27% of total billed charges,177.41,37.27,,141.93,percent of total billed charges,37.27% 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,190.4,40,,152.32,percent of total billed charges,40% of total billed charges,177.41,380.8,
DRILL BIT AR897325,5801832,CDM,272,RC,,,Outpatient,,,274,219.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,219.2,80,,175.36,percent of total billed charges,80% of total billed charges,102.12,37.27,,81.7,percent of total billed charges,37.27% of total billed charges,102.12,37.27,,81.7,percent of total billed charges,37.27% of total billed charges,102.12,37.27,,81.7,percent of total billed charges,37.27% 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,109.6,40,,87.68,percent of total billed charges,40% of total billed charges,102.12,219.2,
DRILL BIT AR897337,5801832,CDM,272,RC,,,Outpatient,,,375,300.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,300,80,,240,percent of total billed charges,80% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% of total billed charges,139.76,37.27,,111.81,percent of total billed charges,37.27% 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,150,40,,120,percent of total billed charges,40% of total billed charges,139.76,300,
IMPLANT SYS AR8973DS,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2021,1616.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1616.8,80,,1293.44,percent of total billed charges,80% of total billed charges,753.23,37.27,,602.58,percent of total billed charges,37.27% of total billed charges,753.23,37.27,,602.58,percent of total billed charges,37.27% of total billed charges,753.23,37.27,,602.58,percent of total billed charges,37.27% 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,808.4,40,,646.72,percent of total billed charges,40% of total billed charges,753.23,1616.8,
FIB NAIL AR8973L3013,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,8198,6558.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,6558.4,80,,5246.72,percent of total billed charges,80% of total billed charges,3055.39,37.27,,2444.31,percent of total billed charges,37.27% of total billed charges,3055.39,37.27,,2444.31,percent of total billed charges,37.27% of total billed charges,3055.39,37.27,,2444.31,percent of total billed charges,37.27% 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,3279.2,40,,2623.36,percent of total billed charges,40% of total billed charges,3055.39,6558.4,
PLATE 7HOLE 628027,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3614,2891.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2891.2,80,,2312.96,percent of total billed charges,80% of total billed charges,1346.94,37.27,,1077.55,percent of total billed charges,37.27% of total billed charges,1346.94,37.27,,1077.55,percent of total billed charges,37.27% of total billed charges,1346.94,37.27,,1077.55,percent of total billed charges,37.27% 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,1445.6,40,,1156.48,percent of total billed charges,40% of total billed charges,1346.94,2891.2,
ACETAB SH 121732052,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,4820,3856.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3856,80,,3084.8,percent of total billed charges,80% of total billed charges,1796.41,37.27,,1437.13,percent of total billed charges,37.27% of total billed charges,1796.41,37.27,,1437.13,percent of total billed charges,37.27% of total billed charges,1796.41,37.27,,1437.13,percent of total billed charges,37.27% 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,1928,40,,1542.4,percent of total billed charges,40% of total billed charges,1796.41,3856,
ACETAB LIN 122136152,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,2453,1962.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1962.4,80,,1569.92,percent of total billed charges,80% of total billed charges,914.23,37.27,,731.38,percent of total billed charges,37.27% of total billed charges,914.23,37.27,,731.38,percent of total billed charges,37.27% of total billed charges,914.23,37.27,,731.38,percent of total billed charges,37.27% 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,981.2,40,,784.96,percent of total billed charges,40% of total billed charges,914.23,1962.4,
FEM HEAD 136536710,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,12076,9660.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,9660.8,80,,7728.64,percent of total billed charges,80% of total billed charges,4500.73,37.27,,3600.58,percent of total billed charges,37.27% of total billed charges,4500.73,37.27,,3600.58,percent of total billed charges,37.27% of total billed charges,4500.73,37.27,,3600.58,percent of total billed charges,37.27% 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,4830.4,40,,3864.32,percent of total billed charges,40% of total billed charges,4500.73,9660.8,
SWB IV INF INIT HR,5811182,CDM,260,RC,,,Outpatient,,,526,420.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,420.8,80,,336.64,percent of total billed charges,80% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% of total billed charges,196.04,37.27,,156.83,percent of total billed charges,37.27% 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,210.4,40,,168.32,percent of total billed charges,40% of total billed charges,196.04,420.8,
SWB IV INF EA ADL HR,5811182,CDM,260,RC,,,Outpatient,,,123,98.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,98.4,80,,78.72,percent of total billed charges,80% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% of total billed charges,45.84,37.27,,36.67,percent of total billed charges,37.27% 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,49.2,40,,39.36,percent of total billed charges,40% of total billed charges,45.84,98.4,
CLAV PLATE AR2651CR,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2454,1963.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1963.2,80,,1570.56,percent of total billed charges,80% of total billed charges,914.61,37.27,,731.69,percent of total billed charges,37.27% of total billed charges,914.61,37.27,,731.69,percent of total billed charges,37.27% of total billed charges,914.61,37.27,,731.69,percent of total billed charges,37.27% 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,981.6,40,,785.28,percent of total billed charges,40% of total billed charges,914.61,1963.2,
SCREW AR266522H,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,650,520.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,520,80,,416,percent of total billed charges,80% of total billed charges,242.26,37.27,,193.81,percent of total billed charges,37.27% of total billed charges,242.26,37.27,,193.81,percent of total billed charges,37.27% of total billed charges,242.26,37.27,,193.81,percent of total billed charges,37.27% 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,260,40,,208,percent of total billed charges,40% of total billed charges,242.26,520,
FIBERTAPE AR7268R,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1516,1212.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1212.8,80,,970.24,percent of total billed charges,80% of total billed charges,565.01,37.27,,452.01,percent of total billed charges,37.27% of total billed charges,565.01,37.27,,452.01,percent of total billed charges,37.27% of total billed charges,565.01,37.27,,452.01,percent of total billed charges,37.27% 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,606.4,40,,485.12,percent of total billed charges,40% of total billed charges,565.01,1212.8,
TENSION DISP AR7820,5801832,CDM,272,RC,,,Outpatient,,,794,635.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,635.2,80,,508.16,percent of total billed charges,80% of total billed charges,295.92,37.27,,236.74,percent of total billed charges,37.27% of total billed charges,295.92,37.27,,236.74,percent of total billed charges,37.27% of total billed charges,295.92,37.27,,236.74,percent of total billed charges,37.27% 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,317.6,40,,254.08,percent of total billed charges,40% of total billed charges,295.92,635.2,
STRAIG PASSER AR7825,5801832,CDM,272,RC,,,Outpatient,,,950,760.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,760,80,,608,percent of total billed charges,80% of total billed charges,354.07,37.27,,283.26,percent of total billed charges,37.27% of total billed charges,354.07,37.27,,283.26,percent of total billed charges,37.27% of total billed charges,354.07,37.27,,283.26,percent of total billed charges,37.27% 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,380,40,,304,percent of total billed charges,40% of total billed charges,354.07,760,
SCREW AR883514,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,101,80.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% 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,40.4,40,,32.32,percent of total billed charges,40% of total billed charges,37.64,80.8,
SCREW AR883518,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,101,80.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% 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,40.4,40,,32.32,percent of total billed charges,40% of total billed charges,37.64,80.8,
SCREW AR883520,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,101,80.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80.8,80,,64.64,percent of total billed charges,80% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% of total billed charges,37.64,37.27,,30.11,percent of total billed charges,37.27% 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,40.4,40,,32.32,percent of total billed charges,40% of total billed charges,37.64,80.8,
SCREW AR8835L16,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,332,265.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,265.6,80,,212.48,percent of total billed charges,80% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% 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,132.8,40,,106.24,percent of total billed charges,40% of total billed charges,123.74,265.6,
SCREW AR8835L18,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,332,265.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,265.6,80,,212.48,percent of total billed charges,80% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% 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,132.8,40,,106.24,percent of total billed charges,40% of total billed charges,123.74,265.6,
SCREW AR8835L20,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,332,265.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,265.6,80,,212.48,percent of total billed charges,80% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% of total billed charges,123.74,37.27,,98.99,percent of total billed charges,37.27% 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,132.8,40,,106.24,percent of total billed charges,40% of total billed charges,123.74,265.6,
SCREWDRIVER AR889431,5801832,CDM,272,RC,,,Outpatient,,,1140,912.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,912,80,,729.6,percent of total billed charges,80% of total billed charges,424.88,37.27,,339.9,percent of total billed charges,37.27% of total billed charges,424.88,37.27,,339.9,percent of total billed charges,37.27% of total billed charges,424.88,37.27,,339.9,percent of total billed charges,37.27% 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,456,40,,364.8,percent of total billed charges,40% of total billed charges,424.88,912,
DRILL BIT AR894313,5801832,CDM,272,RC,,,Outpatient,,,245,196.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,196,80,,156.8,percent of total billed charges,80% of total billed charges,91.31,37.27,,73.05,percent of total billed charges,37.27% of total billed charges,91.31,37.27,,73.05,percent of total billed charges,37.27% of total billed charges,91.31,37.27,,73.05,percent of total billed charges,37.27% 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,98,40,,78.4,percent of total billed charges,40% of total billed charges,91.31,196,
RETRACTOR AR894322,5801832,CDM,272,RC,,,Outpatient,,,188,150.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,150.4,80,,120.32,percent of total billed charges,80% of total billed charges,70.07,37.27,,56.06,percent of total billed charges,37.27% of total billed charges,70.07,37.27,,56.06,percent of total billed charges,37.27% of total billed charges,70.07,37.27,,56.06,percent of total billed charges,37.27% 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,75.2,40,,60.16,percent of total billed charges,40% of total billed charges,70.07,150.4,
RAD PLAT AR8916VNR03,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2296,1836.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1836.8,80,,1469.44,percent of total billed charges,80% of total billed charges,855.72,37.27,,684.58,percent of total billed charges,37.27% of total billed charges,855.72,37.27,,684.58,percent of total billed charges,37.27% of total billed charges,855.72,37.27,,684.58,percent of total billed charges,37.27% 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,918.4,40,,734.72,percent of total billed charges,40% of total billed charges,855.72,1836.8,
NM TC99M DTPA IV,6092513,CDM,344,RC,A9539,HCPCS,Outpatient,,,160,128.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,128,80,,102.4,percent of total billed charges,80% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% of total billed charges,59.63,37.27,,47.7,percent of total billed charges,37.27% 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,64,40,,51.2,percent of total billed charges,40% of total billed charges,59.63,128,
FLUZONE 0.5ML,6065130,CDM,636,RC,,,Outpatient,,,168.2,134.56,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,134.56,80,,107.65,percent of total billed charges,80% of total billed charges,62.69,37.27,,50.15,percent of total billed charges,37.27% of total billed charges,62.69,37.27,,50.15,percent of total billed charges,37.27% of total billed charges,62.69,37.27,,50.15,percent of total billed charges,37.27% 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,67.28,40,,53.82,percent of total billed charges,40% of total billed charges,62.69,134.56,
GLENOSPHE 7742115313,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,3300,2640.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2640,80,,2112,percent of total billed charges,80% of total billed charges,1229.91,37.27,,983.93,percent of total billed charges,37.27% of total billed charges,1229.91,37.27,,983.93,percent of total billed charges,37.27% of total billed charges,1229.91,37.27,,983.93,percent of total billed charges,37.27% 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,1320,40,,1056,percent of total billed charges,40% of total billed charges,1229.91,2640,
HUMERAL STEM 113631,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,10450,8360.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,8360,80,,6688,percent of total billed charges,80% of total billed charges,3894.72,37.27,,3115.78,percent of total billed charges,37.27% of total billed charges,3894.72,37.27,,3115.78,percent of total billed charges,37.27% of total billed charges,3894.72,37.27,,3115.78,percent of total billed charges,37.27% 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,4180,40,,3344,percent of total billed charges,40% of total billed charges,3894.72,8360,
SCREW 115393,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,275,220.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,220,80,,176,percent of total billed charges,80% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% of total billed charges,102.49,37.27,,81.99,percent of total billed charges,37.27% 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,110,40,,88,percent of total billed charges,40% of total billed charges,102.49,220,
MORPHINE INJ 10MG/ML,6400014,CDM,250,RC,,,Outpatient,,,12.5,10.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,10,80,,8,percent of total billed charges,80% of total billed charges,4.66,37.27,,3.73,percent of total billed charges,37.27% of total billed charges,4.66,37.27,,3.73,percent of total billed charges,37.27% of total billed charges,4.66,37.27,,3.73,percent of total billed charges,37.27% 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,5,40,,4,percent of total billed charges,40% of total billed charges,4.66,10,
VACCINE ADMIN EA ADD,9397936,CDM,771,RC,90472,HCPCS,Outpatient,,,100,80.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.62,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,40,,32,percent of total billed charges,40% of total billed charges,19.62,80,
ISOVUE 300,6000905,CDM,255,RC,Q9967,HCPCS,Outpatient,,,125,100.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,100,80,,80,percent of total billed charges,80% of total billed charges,46.59,37.27,,37.27,percent of total billed charges,37.27% of total billed charges,46.59,37.27,,37.27,percent of total billed charges,37.27% of total billed charges,46.59,37.27,,37.27,percent of total billed charges,37.27% 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,50,40,,40,percent of total billed charges,40% of total billed charges,46.59,100,
INSERT FOLEY CATH SI,8400010,CDM,760,RC,51702,HCPCS,Outpatient,,,136,108.80,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,108.8,80,,87.04,percent of total billed charges,80% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,50.69,37.27,,40.55,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,35.47,100,,,case rate,pays based on per visit rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,54.4,40,,43.52,percent of total billed charges,40% of total billed charges,35.47,108.8,
INSERT FOLEY CATH CO,8400010,CDM,760,RC,51703,HCPCS,Outpatient,,,198,158.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,106.68,100,,,case rate,pays based on per visit rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,40,,63.36,percent of total billed charges,40% of total billed charges,73.79,158.4,
VACCINE ADMIN EA ADD,9397936,CDM,771,RC,90472,HCPCS,Outpatient,,,100,80.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.62,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,40,,32,percent of total billed charges,40% of total billed charges,19.62,80,
INSERT FOLEY CATH CO,8400010,CDM,760,RC,51703,HCPCS,Outpatient,,,198,158.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,106.68,100,,,case rate,pays based on per visit rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,40,,63.36,percent of total billed charges,40% of total billed charges,73.79,158.4,
PHOTO THERAPY,8400010,CDM,760,RC,,,Outpatient,,,105,84.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,84,80,,67.2,percent of total billed charges,80% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% of total billed charges,39.13,37.27,,31.3,percent of total billed charges,37.27% 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,42,40,,33.6,percent of total billed charges,40% of total billed charges,39.13,84,
PICC LINE DECLOTTING,8400010,CDM,760,RC,36593,HCPCS,Outpatient,,,475,380.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,380,80,,304,percent of total billed charges,80% of total billed charges,177.03,37.27,,141.62,percent of total billed charges,37.27% of total billed charges,177.03,37.27,,141.62,percent of total billed charges,37.27% of total billed charges,177.03,37.27,,141.62,percent of total billed charges,37.27% of total billed charges,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,44.23,100,,,case rate,pays based on per visit rate,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,279.23,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,190,40,,152,percent of total billed charges,40% of total billed charges,44.23,380,
INSERT FOLEY CATH CO,8400010,CDM,760,RC,51703,HCPCS,Outpatient,,,198,158.40,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,158.4,80,,126.72,percent of total billed charges,80% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,73.79,37.27,,59.03,percent of total billed charges,37.27% of total billed charges,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,106.68,100,,,case rate,pays based on per visit rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,128.79,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,79.2,40,,63.36,percent of total billed charges,40% of total billed charges,73.79,158.4,
BLADDER SCAN,8400010,CDM,760,RC,51798,HCPCS,Outpatient,,,140,112.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,112,80,,89.6,percent of total billed charges,80% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,52.18,37.27,,41.74,percent of total billed charges,37.27% of total billed charges,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,14.5,100,,,case rate,pays based on per visit rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,50.43,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,56,40,,44.8,percent of total billed charges,40% of total billed charges,14.5,112,
VACCINE ADMIN EA ADD,9397936,CDM,771,RC,90472,HCPCS,Outpatient,,,100,80.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,80,80,,64,percent of total billed charges,80% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,37.27,37.27,,29.82,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,19.62,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,40,,32,percent of total billed charges,40% of total billed charges,19.62,80,
CENTRAL LINE INSERT,5612346,CDM,761,RC,SURG,HCPCS,Outpatient,,,2946,2356.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2356.8,80,,1885.44,percent of total billed charges,80% of total billed charges,1097.97,37.27,,878.38,percent of total billed charges,37.27% of total billed charges,1097.97,37.27,,878.38,percent of total billed charges,37.27% of total billed charges,1097.97,37.27,,878.38,percent of total billed charges,37.27% 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,1178.4,40,,942.72,percent of total billed charges,40% of total billed charges,1097.97,2356.8,
CLAV FRC PL AR2654CL,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2454,1963.20,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1963.2,80,,1570.56,percent of total billed charges,80% of total billed charges,914.61,37.27,,731.69,percent of total billed charges,37.27% of total billed charges,914.61,37.27,,731.69,percent of total billed charges,37.27% of total billed charges,914.61,37.27,,731.69,percent of total billed charges,37.27% 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,981.6,40,,785.28,percent of total billed charges,40% of total billed charges,914.61,1963.2,
LOBSTR CLAW AR894323,5801832,CDM,272,RC,,,Outpatient,,,649.69,519.75,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,519.75,80,,415.8,percent of total billed charges,80% of total billed charges,242.14,37.27,,193.71,percent of total billed charges,37.27% of total billed charges,242.14,37.27,,193.71,percent of total billed charges,37.27% of total billed charges,242.14,37.27,,193.71,percent of total billed charges,37.27% 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,259.88,40,,207.9,percent of total billed charges,40% of total billed charges,242.14,519.75,
DRILL BIT 705133,5801832,CDM,272,RC,,,Outpatient,,,542,433.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,433.6,80,,346.88,percent of total billed charges,80% of total billed charges,202,37.27,,161.6,percent of total billed charges,37.27% of total billed charges,202,37.27,,161.6,percent of total billed charges,37.27% of total billed charges,202,37.27,,161.6,percent of total billed charges,37.27% 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,216.8,40,,173.44,percent of total billed charges,40% of total billed charges,202,433.6,
SCREW 655710,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,363,290.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,135.29,37.27,,108.23,percent of total billed charges,37.27% of total billed charges,135.29,37.27,,108.23,percent of total billed charges,37.27% of total billed charges,135.29,37.27,,108.23,percent of total billed charges,37.27% 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,145.2,40,,116.16,percent of total billed charges,40% of total billed charges,135.29,290.4,
SCREW 657712,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,363,290.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,290.4,80,,232.32,percent of total billed charges,80% of total billed charges,135.29,37.27,,108.23,percent of total billed charges,37.27% of total billed charges,135.29,37.27,,108.23,percent of total billed charges,37.27% of total billed charges,135.29,37.27,,108.23,percent of total billed charges,37.27% 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,145.2,40,,116.16,percent of total billed charges,40% of total billed charges,135.29,290.4,
OB PICC LINE INSERT,5612346,CDM,761,RC,36569,HCPCS,Outpatient,,,2700,2160.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2160,80,,1728,percent of total billed charges,80% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1006.29,37.27,,805.03,percent of total billed charges,37.27% of total billed charges,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,133.08,100,,,case rate,pays based on per visit rate,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,1320.48,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1080,40,,864,percent of total billed charges,40% of total billed charges,133.08,2160,
OB MIDLINE INSERTION,5612346,CDM,761,RC,36410,HCPCS,Outpatient,,,2400,1920.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1920,80,,1536,percent of total billed charges,80% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,894.48,37.27,,715.58,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,12.75,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,960,40,,768,percent of total billed charges,40% of total billed charges,12.75,1920,
SIX MINUTE WALK TEST,7441215,CDM,460,RC,94618,HCPCS,Outpatient,,,350,280.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,280,80,,224,percent of total billed charges,80% of total billed charges,130.45,37.27,,104.36,percent of total billed charges,37.27% of total billed charges,130.45,37.27,,104.36,percent of total billed charges,37.27% of total billed charges,130.45,37.27,,104.36,percent of total billed charges,37.27% of total billed charges,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,15.76,100,,,case rate,pays based on per visit rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,105.32,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,140,40,,112,percent of total billed charges,40% of total billed charges,15.76,280,
SMOKING CESSA <10 MI,7441215,CDM,460,RC,99406,HCPCS,Outpatient,,,40,32.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,32,80,,25.6,percent of total billed charges,80% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,14.91,37.27,,11.93,percent of total billed charges,37.27% of total billed charges,23.65,100,,,fee schedule,100% of APC rate,23.65,100,,,fee schedule,100% of APC rate,23.65,100,,,fee schedule,100% of APC rate,16.49,100,,,case rate,pays based on per visit rate,23.65,100,,,fee schedule,100% of APC rate,23.65,100,,,fee schedule,100% of APC rate,23.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,16,40,,12.8,percent of total billed charges,40% of total billed charges,14.91,32,
SMOKING CESSA >10 MI,7441215,CDM,460,RC,99407,HCPCS,Outpatient,,,50,40.00,  ,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,40,80,,32,percent of total billed charges,80% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,18.64,37.27,,14.91,percent of total billed charges,37.27% of total billed charges,23.65,100,,,fee schedule,100% of APC rate,23.65,100,,,fee schedule,100% of APC rate,23.65,100,,,fee schedule,100% of APC rate,34.79,100,,,case rate,pays based on per visit rate,23.65,100,,,fee schedule,100% of APC rate,23.65,100,,,fee schedule,100% of APC rate,23.65,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,20,40,,16,percent of total billed charges,40% of total billed charges,18.64,40,
XARELTO 2.5MG,,,630,RC,,,Outpatient,,,38.85,31.08,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,31.08,80,,24.86,percent of total billed charges,80% of total billed charges,14.48,37.27,,11.58,percent of total billed charges,37.27% of total billed charges,14.48,37.27,,11.58,percent of total billed charges,37.27% of total billed charges,14.48,37.27,,11.58,percent of total billed charges,37.27% 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,15.54,40,,12.43,percent of total billed charges,40% of total billed charges,14.48,31.08,
TRANEXAMIC ACID 650M,,,630,RC,,,Outpatient,,,17.55,14.04,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,14.04,80,,11.23,percent of total billed charges,80% of total billed charges,6.54,37.27,,5.23,percent of total billed charges,37.27% of total billed charges,6.54,37.27,,5.23,percent of total billed charges,37.27% of total billed charges,6.54,37.27,,5.23,percent of total billed charges,37.27% 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,7.02,40,,5.62,percent of total billed charges,40% of total billed charges,6.54,14.04,
US PREG TRANSAB <14,6000566,CDM,402,RC,76801,HCPCS,Outpatient,,,640,512.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,512,80,,409.6,percent of total billed charges,80% of total billed charges,238.53,37.27,,190.82,percent of total billed charges,37.27% of total billed charges,238.53,37.27,,190.82,percent of total billed charges,37.27% of total billed charges,238.53,37.27,,190.82,percent of total billed charges,37.27% of total billed charges,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.18,100,,,case rate,pays based on per visit rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,90.64,100,,,fee schedule,100% of APC rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,256,40,,204.8,percent of total billed charges,40% of total billed charges,90.18,512,
US PREG TRANSAB <14,6000566,CDM,402,RC,76802,HCPCS,Outpatient,,,675,540.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,540,80,,432,percent of total billed charges,80% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% of total billed charges,251.57,37.27,,201.26,percent of total billed charges,37.27% of total billed charges,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,26.64,100,,,case rate,pays based on per visit rate,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,270,40,,216,percent of total billed charges,40% of total billed charges,26.64,540,
DRILL 542000,5801832,CDM,272,RC,,,Outpatient,,,635,508.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,508,80,,406.4,percent of total billed charges,80% of total billed charges,236.66,37.27,,189.33,percent of total billed charges,37.27% of total billed charges,236.66,37.27,,189.33,percent of total billed charges,37.27% of total billed charges,236.66,37.27,,189.33,percent of total billed charges,37.27% 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,254,40,,203.2,percent of total billed charges,40% of total billed charges,236.66,508,
DRILL 542022,5801832,CDM,272,RC,,,Outpatient,,,652,521.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,521.6,80,,417.28,percent of total billed charges,80% of total billed charges,243,37.27,,194.4,percent of total billed charges,37.27% of total billed charges,243,37.27,,194.4,percent of total billed charges,37.27% of total billed charges,243,37.27,,194.4,percent of total billed charges,37.27% 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,260.8,40,,208.64,percent of total billed charges,40% of total billed charges,243,521.6,
PLATE 540646,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,2866,2292.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2292.8,80,,1834.24,percent of total billed charges,80% of total billed charges,1068.16,37.27,,854.53,percent of total billed charges,37.27% of total billed charges,1068.16,37.27,,854.53,percent of total billed charges,37.27% of total billed charges,1068.16,37.27,,854.53,percent of total billed charges,37.27% 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,1146.4,40,,917.12,percent of total billed charges,40% of total billed charges,1068.16,2292.8,
SCREW 661412,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,96,76.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% 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,38.4,40,,30.72,percent of total billed charges,40% of total billed charges,35.78,76.8,
SCREW 661446,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,96,76.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% 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,38.4,40,,30.72,percent of total billed charges,40% of total billed charges,35.78,76.8,
SCREW 661442,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,96,76.80,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,76.8,80,,61.44,percent of total billed charges,80% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% of total billed charges,35.78,37.27,,28.62,percent of total billed charges,37.27% 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,38.4,40,,30.72,percent of total billed charges,40% of total billed charges,35.78,76.8,
SCREW 541510,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,569,455.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,455.2,80,,364.16,percent of total billed charges,80% of total billed charges,212.07,37.27,,169.66,percent of total billed charges,37.27% of total billed charges,212.07,37.27,,169.66,percent of total billed charges,37.27% of total billed charges,212.07,37.27,,169.66,percent of total billed charges,37.27% 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,227.6,40,,182.08,percent of total billed charges,40% of total billed charges,212.07,455.2,
SCREW 541512,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,569,455.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,455.2,80,,364.16,percent of total billed charges,80% of total billed charges,212.07,37.27,,169.66,percent of total billed charges,37.27% of total billed charges,212.07,37.27,,169.66,percent of total billed charges,37.27% of total billed charges,212.07,37.27,,169.66,percent of total billed charges,37.27% 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,227.6,40,,182.08,percent of total billed charges,40% of total billed charges,212.07,455.2,
SCREW 541412,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,517,413.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413.6,80,,330.88,percent of total billed charges,80% of total billed charges,192.69,37.27,,154.15,percent of total billed charges,37.27% of total billed charges,192.69,37.27,,154.15,percent of total billed charges,37.27% of total billed charges,192.69,37.27,,154.15,percent of total billed charges,37.27% 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,206.8,40,,165.44,percent of total billed charges,40% of total billed charges,192.69,413.6,
SCREW 541416,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,517,413.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413.6,80,,330.88,percent of total billed charges,80% of total billed charges,192.69,37.27,,154.15,percent of total billed charges,37.27% of total billed charges,192.69,37.27,,154.15,percent of total billed charges,37.27% of total billed charges,192.69,37.27,,154.15,percent of total billed charges,37.27% 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,206.8,40,,165.44,percent of total billed charges,40% of total billed charges,192.69,413.6,
SCREW 541414,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,517,413.60,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,413.6,80,,330.88,percent of total billed charges,80% of total billed charges,192.69,37.27,,154.15,percent of total billed charges,37.27% of total billed charges,192.69,37.27,,154.15,percent of total billed charges,37.27% of total billed charges,192.69,37.27,,154.15,percent of total billed charges,37.27% 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,206.8,40,,165.44,percent of total billed charges,40% of total billed charges,192.69,413.6,
REAMER AR1409LPV,5645742,CDM,270,RC,,,Outpatient,,,563,450.40,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,450.4,80,,360.32,percent of total billed charges,80% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% of total billed charges,209.83,37.27,,167.86,percent of total billed charges,37.27% 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,225.2,40,,180.16,percent of total billed charges,40% of total billed charges,209.83,450.4,
PUSHLOCK AR1926BCSP,8605396,CDM,278,RC,C1713,HCPCS,Outpatient,,,1299,1039.20,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,1039.2,80,,831.36,percent of total billed charges,80% of total billed charges,484.14,37.27,,387.31,percent of total billed charges,37.27% of total billed charges,484.14,37.27,,387.31,percent of total billed charges,37.27% of total billed charges,484.14,37.27,,387.31,percent of total billed charges,37.27% 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,519.6,40,,415.68,percent of total billed charges,40% of total billed charges,484.14,1039.2,
ORTHOFIX CDM635L,8605396,CDM,278,RC,C1776,HCPCS,Outpatient,,,16500,13200.00,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,13200,80,,10560,percent of total billed charges,80% of total billed charges,6149.55,37.27,,4919.64,percent of total billed charges,37.27% of total billed charges,6149.55,37.27,,4919.64,percent of total billed charges,37.27% of total billed charges,6149.55,37.27,,4919.64,percent of total billed charges,37.27% 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,6600,40,,5280,percent of total billed charges,40% of total billed charges,6149.55,13200,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC,1,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC,2,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"ECMO OR TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITH MAJOR O.R. PROCEDURES",3,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"TRACHEOSTOMY WITH MV >96 HOURS OR PRINCIPAL DIAGNOSIS EXCEPT FACE, MOUTH AND NECK WITHOUT MAJOR O.R. PROCEDURES",4,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LIVER TRANSPLANT WITH MCC OR INTESTINAL TRANSPLANT,5,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LIVER TRANSPLANT WITHOUT MCC,6,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LUNG TRANSPLANT,7,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT,8,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
PANCREAS TRANSPLANT,10,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH MCC",11,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITH CC",12,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"TRACHEOSTOMY FOR FACE, MOUTH AND NECK DIAGNOSES OR LARYNGECTOMY WITHOUT CC/MCC",13,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
ALLOGENEIC BONE MARROW TRANSPLANT,14,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
AUTOLOGOUS BONE MARROW TRANSPLANT WITH CC/MCC,16,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
AUTOLOGOUS BONE MARROW TRANSPLANT WITHOUT CC/MCC,17,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES,18,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SIMULTANEOUS PANCREAS AND KIDNEY TRANSPLANT WITH HEMODIALYSIS,19,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH MCC,20,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITH CC,21,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
INTRACRANIAL VASCULAR PROCEDURES WITH PRINCIPAL DIAGNOSIS HEMORRHAGE WITHOUT CC/MCC,22,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SPINAL PROCEDURES WITH MCC,28,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SPINAL PROCEDURES WITHOUT CC/MCC,30,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
VENTRICULAR SHUNT PROCEDURES WITH MCC,31,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
VENTRICULAR SHUNT PROCEDURES WITH CC,32,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
VENTRICULAR SHUNT PROCEDURES WITHOUT CC/MCC,33,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITH MCC",40,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"PERIPHERAL, CRANIAL NERVE AND OTHER NERVOUS SYSTEM PROCEDURES WITHOUT CC/MCC",42,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SPINAL DISORDERS AND INJURIES WITH CC/MCC,52,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SPINAL DISORDERS AND INJURIES WITHOUT CC/MCC,53,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NERVOUS SYSTEM NEOPLASMS WITH MCC,54,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC,55,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITH MCC,56,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DEGENERATIVE NERVOUS SYSTEM DISORDERS WITHOUT MCC,57,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH MCC,58,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITH CC,59,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MULTIPLE SCLEROSIS AND CEREBELLAR ATAXIA WITHOUT CC/MCC,60,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH MCC",61,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITH CC",62,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"ISCHEMIC STROKE, PRECEREBRAL OCCLUSION OR TRANSIENT ISCHEMIA WITH THROMBOLYTIC AGENT WITHOUT CC/MCC",63,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH MCC,64,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITH CC OR TPA IN 24 HOURS,65,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
INTRACRANIAL HEMORRHAGE OR CEREBRAL INFARCTION WITHOUT CC/MCC,66,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITH MCC,67,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NONSPECIFIC CVA AND PRECEREBRAL OCCLUSION WITHOUT INFARCTION WITHOUT MCC,68,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
TRANSIENT ISCHEMIA WITHOUT THROMBOLYTIC,69,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH MCC,70,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITH CC,71,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NONSPECIFIC CEREBROVASCULAR DISORDERS WITHOUT CC/MCC,72,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITH MCC,73,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CRANIAL AND PERIPHERAL NERVE DISORDERS WITHOUT MCC,74,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
VIRAL MENINGITIS WITH CC/MCC,75,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
VIRAL MENINGITIS WITHOUT CC/MCC,76,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
HYPERTENSIVE ENCEPHALOPATHY WITH MCC,77,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
HYPERTENSIVE ENCEPHALOPATHY WITH CC,78,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
HYPERTENSIVE ENCEPHALOPATHY WITHOUT CC/MCC,79,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NONTRAUMATIC STUPOR AND COMA WITH MCC,80,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NONTRAUMATIC STUPOR AND COMA WITHOUT MCC,81,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH MCC,82,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
TRAUMATIC STUPOR AND COMA >1 HOUR WITH CC,83,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
TRAUMATIC STUPOR AND COMA >1 HOUR WITHOUT CC/MCC,84,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH MCC,85,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
TRAUMATIC STUPOR AND COMA <1 HOUR WITH CC,86,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
TRAUMATIC STUPOR AND COMA <1 HOUR WITHOUT CC/MCC,87,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CONCUSSION WITH MCC,88,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CONCUSSION WITH CC,89,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CONCUSSION WITHOUT CC/MCC,90,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER DISORDERS OF NERVOUS SYSTEM WITH MCC,91,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER DISORDERS OF NERVOUS SYSTEM WITH CC,92,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER DISORDERS OF NERVOUS SYSTEM WITHOUT CC/MCC,93,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH MCC,94,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITH CC,95,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
BACTERIAL AND TUBERCULOUS INFECTIONS OF NERVOUS SYSTEM WITHOUT CC/MCC,96,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH MCC,97,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITH CC,98,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NON-BACTERIAL INFECTION OF NERVOUS SYSTEM EXCEPT VIRAL MENINGITIS WITHOUT CC/MCC,99,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SEIZURES WITH MCC,100,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SEIZURES WITHOUT MCC,101,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
HEADACHES WITH MCC,102,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
HEADACHES WITHOUT MCC,103,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ORBITAL PROCEDURES WITH CC/MCC,113,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
ORBITAL PROCEDURES WITHOUT CC/MCC,114,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
EXTRAOCULAR PROCEDURES EXCEPT ORBIT,115,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
INTRAOCULAR PROCEDURES WITH CC/MCC,116,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
INTRAOCULAR PROCEDURES WITHOUT CC/MCC,117,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
ACUTE MAJOR EYE INFECTIONS WITH CC/MCC,121,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ACUTE MAJOR EYE INFECTIONS WITHOUT CC/MCC,122,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NEUROLOGICAL EYE DISORDERS,123,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER DISORDERS OF THE EYE WITH MCC OR THROMBOLYTIC AGENT,124,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER DISORDERS OF THE EYE WITHOUT MCC,125,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SINUS AND MASTOID PROCEDURES WITH CC/MCC,135,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SINUS AND MASTOID PROCEDURES WITHOUT CC/MCC,136,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MOUTH PROCEDURES WITH CC/MCC,137,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MOUTH PROCEDURES WITHOUT CC/MCC,138,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SALIVARY GLAND PROCEDURES,139,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR HEAD AND NECK PROCEDURES WITH MCC,140,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR HEAD AND NECK PROCEDURES WITH CC,141,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR HEAD AND NECK PROCEDURES WITHOUT CC/MCC,142,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC",143,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH CC",144,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC",145,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH MCC",146,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITH CC",147,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"EAR, NOSE, MOUTH AND THROAT MALIGNANCY WITHOUT CC/MCC",148,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DYSEQUILIBRIUM,149,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
EPISTAXIS WITH MCC,150,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
EPISTAXIS WITHOUT MCC,151,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTITIS MEDIA AND URI WITH MCC,152,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTITIS MEDIA AND URI WITHOUT MCC,153,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH MCC",154,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITH CC",155,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"OTHER EAR, NOSE, MOUTH AND THROAT DIAGNOSES WITHOUT CC/MCC",156,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DENTAL AND ORAL DISEASES WITH MCC,157,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DENTAL AND ORAL DISEASES WITH CC,158,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DENTAL AND ORAL DISEASES WITHOUT CC/MCC,159,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MAJOR CHEST PROCEDURES WITH MCC,163,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR CHEST PROCEDURES WITH CC,164,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR CHEST PROCEDURES WITHOUT CC/MCC,165,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH MCC,166,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITH CC,167,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER RESPIRATORY SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,168,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE,175,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PULMONARY EMBOLISM WITHOUT MCC,176,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH MCC,177,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITH CC,178,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RESPIRATORY INFECTIONS AND INFLAMMATIONS WITHOUT CC/MCC,179,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RESPIRATORY NEOPLASMS WITH MCC,180,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RESPIRATORY NEOPLASMS WITH CC,181,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RESPIRATORY NEOPLASMS WITHOUT CC/MCC,182,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MAJOR CHEST TRAUMA WITH MCC,183,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MAJOR CHEST TRAUMA WITH CC,184,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MAJOR CHEST TRAUMA WITHOUT CC/MCC,185,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PLEURAL EFFUSION WITH MCC,186,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PLEURAL EFFUSION WITH CC,187,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PLEURAL EFFUSION WITHOUT CC/MCC,188,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PULMONARY EDEMA AND RESPIRATORY FAILURE,189,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH MCC,190,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITH CC,191,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CHRONIC OBSTRUCTIVE PULMONARY DISEASE WITHOUT CC/MCC,192,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SIMPLE PNEUMONIA AND PLEURISY WITH MCC,193,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SIMPLE PNEUMONIA AND PLEURISY WITH CC,194,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SIMPLE PNEUMONIA AND PLEURISY WITHOUT CC/MCC,195,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
INTERSTITIAL LUNG DISEASE WITH MCC,196,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
INTERSTITIAL LUNG DISEASE WITH CC,197,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
INTERSTITIAL LUNG DISEASE WITHOUT CC/MCC,198,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PNEUMOTHORAX WITH MCC,199,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PNEUMOTHORAX WITH CC,200,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PNEUMOTHORAX WITHOUT CC/MCC,201,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
BRONCHITIS AND ASTHMA WITH CC/MCC,202,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
BRONCHITIS AND ASTHMA WITHOUT CC/MCC,203,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RESPIRATORY SIGNS AND SYMPTOMS,204,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITH MCC,205,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER RESPIRATORY SYSTEM DIAGNOSES WITHOUT MCC,206,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT >96 HOURS,207,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RESPIRATORY SYSTEM DIAGNOSIS WITH VENTILATOR SUPPORT <=96 HOURS,208,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER HEART ASSIST SYSTEM IMPLANT,215,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH MCC,239,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITH CC,240,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS EXCEPT UPPER LIMB AND TOE WITHOUT CC/MCC,241,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH MCC,255,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITH CC,256,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
UPPER LIMB AND TOE AMPUTATION FOR CIRCULATORY SYSTEM DISORDERS WITHOUT CC/MCC,257,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER CIRCULATORY SYSTEM O.R. PROCEDURES,264,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC,266,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITHOUT MCC,267,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC,268,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC,269,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH MCC,270,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITH CC,271,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER MAJOR CARDIOVASCULAR PROCEDURES WITHOUT CC/MCC,272,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITH MCC,273,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
PERCUTANEOUS AND OTHER INTRACARDIAC PROCEDURES WITHOUT MCC,274,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
ACUTE AND SUBACUTE ENDOCARDITIS WITH MCC,288,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ACUTE AND SUBACUTE ENDOCARDITIS WITH CC,289,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ACUTE AND SUBACUTE ENDOCARDITIS WITHOUT CC/MCC,290,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
HEART FAILURE AND SHOCK WITH MCC,291,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
HEART FAILURE AND SHOCK WITH CC,292,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
HEART FAILURE AND SHOCK WITHOUT CC/MCC,293,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DEEP VEIN THROMBOPHLEBITIS WITH CC/MCC,294,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DEEP VEIN THROMBOPHLEBITIS WITHOUT CC/MCC,295,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"CARDIAC ARREST, UNEXPLAINED WITH MCC",296,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"CARDIAC ARREST, UNEXPLAINED WITH CC",297,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC",298,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PERIPHERAL VASCULAR DISORDERS WITH MCC,299,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PERIPHERAL VASCULAR DISORDERS WITH CC,300,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PERIPHERAL VASCULAR DISORDERS WITHOUT CC/MCC,301,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ATHEROSCLEROSIS WITH MCC,302,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ATHEROSCLEROSIS WITHOUT MCC,303,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
HYPERTENSION WITH MCC,304,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
HYPERTENSION WITHOUT MCC,305,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC,306,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC,307,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC,308,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC,309,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC,310,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ANGINA PECTORIS,311,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SYNCOPE AND COLLAPSE,312,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CHEST PAIN,313,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH MCC,314,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITH CC,315,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER CIRCULATORY SYSTEM DIAGNOSES WITHOUT CC/MCC,316,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC,319,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC,320,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH MCC",326,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITH CC",327,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"STOMACH, ESOPHAGEAL AND DUODENAL PROCEDURES WITHOUT CC/MCC",328,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,329,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,330,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,331,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
RECTAL RESECTION WITH MCC,332,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
RECTAL RESECTION WITH CC,333,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
RECTAL RESECTION WITHOUT CC/MCC,334,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
PERITONEAL ADHESIOLYSIS WITH MCC,335,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
PERITONEAL ADHESIOLYSIS WITH CC,336,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
PERITONEAL ADHESIOLYSIS WITHOUT CC/MCC,337,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH MCC,344,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITH CC,345,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MINOR SMALL AND LARGE BOWEL PROCEDURES WITHOUT CC/MCC,346,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
ANAL AND STOMAL PROCEDURES WITH MCC,347,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
ANAL AND STOMAL PROCEDURES WITH CC,348,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
ANAL AND STOMAL PROCEDURES WITHOUT CC/MCC,349,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH MCC,350,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITH CC,351,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
INGUINAL AND FEMORAL HERNIA PROCEDURES WITHOUT CC/MCC,352,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC,353,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC,354,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC,355,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH MCC,356,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITH CC,357,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER DIGESTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,358,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR ESOPHAGEAL DISORDERS WITH MCC,368,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MAJOR ESOPHAGEAL DISORDERS WITH CC,369,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MAJOR ESOPHAGEAL DISORDERS WITHOUT CC/MCC,370,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH MCC,371,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITH CC,372,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MAJOR GASTROINTESTINAL DISORDERS AND PERITONEAL INFECTIONS WITHOUT CC/MCC,373,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DIGESTIVE MALIGNANCY WITH MCC,374,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DIGESTIVE MALIGNANCY WITH CC,375,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DIGESTIVE MALIGNANCY WITHOUT CC/MCC,376,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
GASTROINTESTINAL HEMORRHAGE WITH MCC,377,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
GASTROINTESTINAL HEMORRHAGE WITH CC,378,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC,379,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
COMPLICATED PEPTIC ULCER WITH MCC,380,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
COMPLICATED PEPTIC ULCER WITH CC,381,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
COMPLICATED PEPTIC ULCER WITHOUT CC/MCC,382,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
UNCOMPLICATED PEPTIC ULCER WITH MCC,383,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
UNCOMPLICATED PEPTIC ULCER WITHOUT MCC,384,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
INFLAMMATORY BOWEL DISEASE WITH MCC,385,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
INFLAMMATORY BOWEL DISEASE WITH CC,386,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
INFLAMMATORY BOWEL DISEASE WITHOUT CC/MCC,387,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
GASTROINTESTINAL OBSTRUCTION WITH MCC,388,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
GASTROINTESTINAL OBSTRUCTION WITH CC,389,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC,390,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC",391,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC",392,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH MCC,393,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITH CC,394,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER DIGESTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,395,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH MCC,408,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITH CC,409,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
BILIARY TRACT PROCEDURES EXCEPT ONLY CHOLECYSTECTOMY WITH OR WITHOUT C.D.E. WITHOUT CC/MCC,410,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
CHOLECYSTECTOMY WITH C.D.E. WITH MCC,411,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
CHOLECYSTECTOMY WITH C.D.E. WITH CC,412,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC,413,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC,414,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC,415,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC,416,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC,417,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC,418,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC,419,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH MCC,420,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITH CC,421,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HEPATOBILIARY DIAGNOSTIC PROCEDURES WITHOUT CC/MCC,422,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH MCC,423,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITH CC,424,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER HEPATOBILIARY OR PANCREAS O.R. PROCEDURES WITHOUT CC/MCC,425,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH MCC,432,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITH CC,433,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CIRRHOSIS AND ALCOHOLIC HEPATITIS WITHOUT CC/MCC,434,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH MCC,435,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITH CC,436,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MALIGNANCY OF HEPATOBILIARY SYSTEM OR PANCREAS WITHOUT CC/MCC,437,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH MCC,438,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITH CC,439,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DISORDERS OF PANCREAS EXCEPT MALIGNANCY WITHOUT CC/MCC,440,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH MCC",441,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITH CC",442,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"DISORDERS OF LIVER EXCEPT MALIGNANCY, CIRRHOSIS OR ALCOHOLIC HEPATITIS WITHOUT CC/MCC",443,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DISORDERS OF THE BILIARY TRACT WITH MCC,444,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DISORDERS OF THE BILIARY TRACT WITH CC,445,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DISORDERS OF THE BILIARY TRACT WITHOUT CC/MCC,446,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH MCC,463,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITH CC,464,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
WOUND DEBRIDEMENT AND SKIN GRAFT EXCEPT HAND FOR MUSCULOSKELETAL AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,465,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH MCC,474,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITH CC,475,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
AMPUTATION FOR MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,476,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,477,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC,478,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
BIOPSIES OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC,479,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH MCC,480,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITH CC,481,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HIP AND FEMUR PROCEDURES EXCEPT MAJOR JOINT WITHOUT CC/MCC,482,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH MCC,495,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITH CC,496,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES EXCEPT HIP AND FEMUR WITHOUT CC/MCC,497,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITH CC/MCC,498,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LOCAL EXCISION AND REMOVAL OF INTERNAL FIXATION DEVICES OF HIP AND FEMUR WITHOUT CC/MCC,499,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SOFT TISSUE PROCEDURES WITH MCC,500,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SOFT TISSUE PROCEDURES WITH CC,501,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SOFT TISSUE PROCEDURES WITHOUT CC/MCC,502,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
FOOT PROCEDURES WITH MCC,503,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
FOOT PROCEDURES WITH CC,504,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
FOOT PROCEDURES WITHOUT CC/MCC,505,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR THUMB OR JOINT PROCEDURES,506,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITH CC/MCC,507,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR SHOULDER OR ELBOW JOINT PROCEDURES WITHOUT CC/MCC,508,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
ARTHROSCOPY,509,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH MCC",510,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITH CC",511,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"SHOULDER, ELBOW OR FOREARM PROCEDURES, EXCEPT MAJOR JOINT PROCEDURES WITHOUT CC/MCC",512,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITH CC/MCC",513,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"HAND OR WRIST PROCEDURES, EXCEPT MAJOR THUMB OR JOINT PROCEDURES WITHOUT CC/MCC",514,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH MCC,515,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITH CC,516,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE O.R. PROCEDURES WITHOUT CC/MCC,517,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH MCC OR DISC DEVICE OR NEUROSTIMULATOR,518,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITH CC,519,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
BACK AND NECK PROCEDURES EXCEPT SPINAL FUSION WITHOUT CC/MCC,520,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITH MCC,521,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HIP REPLACEMENT WITH PRINCIPAL DIAGNOSIS OF HIP FRACTURE WITHOUT MCC,522,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
FRACTURES OF FEMUR WITH MCC,533,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
FRACTURES OF FEMUR WITHOUT MCC,534,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
FRACTURES OF HIP AND PELVIS WITH MCC,535,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
FRACTURES OF HIP AND PELVIS WITHOUT MCC,536,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITH CC/MCC",537,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"SPRAINS, STRAINS, AND DISLOCATIONS OF HIP, PELVIS AND THIGH WITHOUT CC/MCC",538,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OSTEOMYELITIS WITH MCC,539,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OSTEOMYELITIS WITH CC,540,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OSTEOMYELITIS WITHOUT CC/MCC,541,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH MCC,542,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITH CC,543,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PATHOLOGICAL FRACTURES AND MUSCULOSKELETAL AND CONNECTIVE TISSUE MALIGNANCY WITHOUT CC/MCC,544,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CONNECTIVE TISSUE DISORDERS WITH MCC,545,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CONNECTIVE TISSUE DISORDERS WITH CC,546,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CONNECTIVE TISSUE DISORDERS WITHOUT CC/MCC,547,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SEPTIC ARTHRITIS WITH MCC,548,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SEPTIC ARTHRITIS WITH CC,549,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SEPTIC ARTHRITIS WITHOUT CC/MCC,550,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MEDICAL BACK PROBLEMS WITH MCC,551,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MEDICAL BACK PROBLEMS WITHOUT MCC,552,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
BONE DISEASES AND ARTHROPATHIES WITH MCC,553,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
BONE DISEASES AND ARTHROPATHIES WITHOUT MCC,554,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC,555,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SIGNS AND SYMPTOMS OF MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT MCC,556,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"TENDONITIS, MYOSITIS AND BURSITIS WITH MCC",557,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"TENDONITIS, MYOSITIS AND BURSITIS WITHOUT MCC",558,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH MCC",559,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITH CC",560,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"AFTERCARE, MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE WITHOUT CC/MCC",561,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITH MCC",562,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"FRACTURE, SPRAIN, STRAIN AND DISLOCATION EXCEPT FEMUR, HIP, PELVIS AND THIGH WITHOUT MCC",563,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH MCC,564,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITH CC,565,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER MUSCULOSKELETAL SYSTEM AND CONNECTIVE TISSUE DIAGNOSES WITHOUT CC/MCC,566,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SKIN DEBRIDEMENT WITH MCC,570,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SKIN DEBRIDEMENT WITH CC,571,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SKIN DEBRIDEMENT WITHOUT CC/MCC,572,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH MCC,573,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITH CC,574,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SKIN GRAFT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,575,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH MCC,576,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITH CC,577,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SKIN GRAFT EXCEPT FOR SKIN ULCER OR CELLULITIS WITHOUT CC/MCC,578,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH MCC",579,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITH CC",580,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"OTHER SKIN, SUBCUTANEOUS TISSUE AND BREAST PROCEDURES WITHOUT CC/MCC",581,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITH CC/MCC",584,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"BREAST BIOPSY, LOCAL EXCISION AND OTHER BREAST PROCEDURES WITHOUT CC/MCC",585,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SKIN ULCERS WITH MCC,592,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SKIN ULCERS WITH CC,593,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SKIN ULCERS WITHOUT CC/MCC,594,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MAJOR SKIN DISORDERS WITH MCC,595,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MAJOR SKIN DISORDERS WITHOUT MCC,596,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MALIGNANT BREAST DISORDERS WITH MCC,597,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MALIGNANT BREAST DISORDERS WITH CC,598,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,599,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NON-MALIGNANT BREAST DISORDERS WITH CC/MCC,600,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NON-MALIGNANT BREAST DISORDERS WITHOUT CC/MCC,601,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CELLULITIS WITH MCC,602,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CELLULITIS WITHOUT MCC,603,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITH MCC",604,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"TRAUMA TO THE SKIN, SUBCUTANEOUS TISSUE AND BREAST WITHOUT MCC",605,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MINOR SKIN DISORDERS WITH MCC,606,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MINOR SKIN DISORDERS WITHOUT MCC,607,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ADRENAL AND PITUITARY PROCEDURES WITH CC/MCC,614,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
ADRENAL AND PITUITARY PROCEDURES WITHOUT CC/MCC,615,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",616,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",617,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"AMPUTATION OF LOWER LIMB FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",618,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH MCC",622,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITH CC",623,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"SKIN GRAFTS AND WOUND DEBRIDEMENT FOR ENDOCRINE, NUTRITIONAL AND METABOLIC DISORDERS WITHOUT CC/MCC",624,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH MCC",625,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITH CC",626,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"THYROID, PARATHYROID AND THYROGLOSSAL PROCEDURES WITHOUT CC/MCC",627,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC",628,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC",629,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC",630,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
DIABETES WITH MCC,637,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DIABETES WITH CC,638,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DIABETES WITHOUT CC/MCC,639,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITH MCC",640,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"MISCELLANEOUS DISORDERS OF NUTRITION, METABOLISM, FLUIDS AND ELECTROLYTES WITHOUT MCC",641,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
INBORN AND OTHER DISORDERS OF METABOLISM,642,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ENDOCRINE DISORDERS WITH MCC,643,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ENDOCRINE DISORDERS WITH CC,644,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ENDOCRINE DISORDERS WITHOUT CC/MCC,645,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITH MCC,650,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
KIDNEY TRANSPLANT WITH HEMODIALYSIS WITHOUT MCC,651,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
KIDNEY TRANSPLANT,652,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR BLADDER PROCEDURES WITH MCC,653,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR BLADDER PROCEDURES WITH CC,654,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MAJOR BLADDER PROCEDURES WITHOUT CC/MCC,655,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH MCC,656,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITH CC,657,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
KIDNEY AND URETER PROCEDURES FOR NEOPLASM WITHOUT CC/MCC,658,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH MCC,659,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITH CC,660,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
KIDNEY AND URETER PROCEDURES FOR NON-NEOPLASM WITHOUT CC/MCC,661,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MINOR BLADDER PROCEDURES WITH MCC,662,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MINOR BLADDER PROCEDURES WITH CC,663,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MINOR BLADDER PROCEDURES WITHOUT CC/MCC,664,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
PROSTATECTOMY WITH MCC,665,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
PROSTATECTOMY WITH CC,666,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
PROSTATECTOMY WITHOUT CC/MCC,667,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
TRANSURETHRAL PROCEDURES WITH MCC,668,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
TRANSURETHRAL PROCEDURES WITH CC,669,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC,670,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
URETHRAL PROCEDURES WITH CC/MCC,671,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
URETHRAL PROCEDURES WITHOUT CC/MCC,672,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH MCC,673,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITH CC,674,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER KIDNEY AND URINARY TRACT PROCEDURES WITHOUT CC/MCC,675,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
RENAL FAILURE WITH MCC,682,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RENAL FAILURE WITH CC,683,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RENAL FAILURE WITHOUT CC/MCC,684,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
KIDNEY AND URINARY TRACT NEOPLASMS WITH MCC,686,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
KIDNEY AND URINARY TRACT NEOPLASMS WITH CC,687,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
KIDNEY AND URINARY TRACT NEOPLASMS WITHOUT CC/MCC,688,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
KIDNEY AND URINARY TRACT INFECTIONS WITH MCC,689,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
KIDNEY AND URINARY TRACT INFECTIONS WITHOUT MCC,690,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
URINARY STONES WITH MCC,693,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
URINARY STONES WITHOUT MCC,694,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITH MCC,695,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
KIDNEY AND URINARY TRACT SIGNS AND SYMPTOMS WITHOUT MCC,696,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
URETHRAL STRICTURE,697,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH MCC,698,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITH CC,699,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER KIDNEY AND URINARY TRACT DIAGNOSES WITHOUT CC/MCC,700,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PENIS PROCEDURES WITH CC/MCC,709,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
PENIS PROCEDURES WITHOUT CC/MCC,710,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
TESTES PROCEDURES WITH CC/MCC,711,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
TESTES PROCEDURES WITHOUT CC/MCC,712,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC,713,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
TRANSURETHRAL PROSTATECTOMY WITHOUT CC/MCC,714,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITH CC/MCC,715,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES FOR MALIGNANCY WITHOUT CC/MCC,716,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITH CC/MCC,717,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER MALE REPRODUCTIVE SYSTEM O.R. PROCEDURES EXCEPT MALIGNANCY WITHOUT CC/MCC,718,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH MCC",722,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITH CC",723,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"MALIGNANCY, MALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",724,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
BENIGN PROSTATIC HYPERTROPHY WITH MCC,725,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
BENIGN PROSTATIC HYPERTROPHY WITHOUT MCC,726,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITH MCC,727,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
INFLAMMATION OF THE MALE REPRODUCTIVE SYSTEM WITHOUT MCC,728,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITH CC/MCC,729,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER MALE REPRODUCTIVE SYSTEM DIAGNOSES WITHOUT CC/MCC,730,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITH CC/MCC",734,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"PELVIC EVISCERATION, RADICAL HYSTERECTOMY AND RADICAL VULVECTOMY WITHOUT CC/MCC",735,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC,736,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC,737,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC,738,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC,739,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC,740,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC,741,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITH CC/MCC,742,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
UTERINE AND ADNEXA PROCEDURES FOR NON-MALIGNANCY WITHOUT CC/MCC,743,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITH CC/MCC",744,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"D&C, CONIZATION, LAPAROSCOPY AND TUBAL INTERRUPTION WITHOUT CC/MCC",745,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC",746,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC",747,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
FEMALE REPRODUCTIVE SYSTEM RECONSTRUCTIVE PROCEDURES,748,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITH CC/MCC,749,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER FEMALE REPRODUCTIVE SYSTEM O.R. PROCEDURES WITHOUT CC/MCC,750,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH MCC",754,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITH CC",755,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"MALIGNANCY, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",756,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH MCC",757,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITH CC",758,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"INFECTIONS, FEMALE REPRODUCTIVE SYSTEM WITHOUT CC/MCC",759,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITH CC/MCC,760,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MENSTRUAL AND OTHER FEMALE REPRODUCTIVE SYSTEM DISORDERS WITHOUT CC/MCC,761,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C,768,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,100,,,case rate,100% of CMS IPPS Rate,2076,100,,,case rate,100% of CMS IPPS Rate,2076,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,2076,
POSTPARTUM AND POST ABORTION DIAGNOSES WITH O.R. PROCEDURES,769,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"ABORTION WITH D&C, ASPIRATION CURETTAGE OR HYSTEROTOMY",770,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
POSTPARTUM AND POST ABORTION DIAGNOSES WITHOUT O.R. PROCEDURES,776,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ABORTION WITHOUT D&C,779,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"NEONATES, DIED OR TRANSFERRED TO ANOTHER ACUTE CARE FACILITY",789,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"EXTREME IMMATURITY OR RESPIRATORY DISTRESS SYNDROME, NEONATE",790,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PREMATURITY WITH MAJOR PROBLEMS,791,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PREMATURITY WITHOUT MAJOR PROBLEMS,792,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
FULL TERM NEONATE WITH MAJOR PROBLEMS,793,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NEONATE WITH OTHER SIGNIFICANT PROBLEMS,794,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NORMAL NEWBORN,795,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC,796,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,100,,,case rate,100% of CMS IPPS Rate,2076,100,,,case rate,100% of CMS IPPS Rate,2076,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,2076,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC,797,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,100,,,case rate,100% of CMS IPPS Rate,2076,100,,,case rate,100% of CMS IPPS Rate,2076,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,2076,
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC,798,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,100,,,case rate,100% of CMS IPPS Rate,2076,100,,,case rate,100% of CMS IPPS Rate,2076,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,2076,
SPLENIC PROCEDURES WITH MCC,799,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SPLENIC PROCEDURES WITH CC,800,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SPLENIC PROCEDURES WITHOUT CC/MCC,801,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH MCC,802,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITH CC,803,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER O.R. PROCEDURES OF THE BLOOD AND BLOOD FORMING ORGANS WITHOUT CC/MCC,804,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC,805,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,100,,,case rate,100% of CMS IPPS Rate,2076,100,,,case rate,100% of CMS IPPS Rate,2076,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,2076,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC,806,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,100,,,case rate,100% of CMS IPPS Rate,2076,100,,,case rate,100% of CMS IPPS Rate,2076,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,2076,
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC,807,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,100,,,case rate,100% of CMS IPPS Rate,2076,100,,,case rate,100% of CMS IPPS Rate,2076,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2076,2076,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH MCC,808,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITH CC,809,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
MAJOR HEMATOLOGICAL AND IMMUNOLOGICAL DIAGNOSES EXCEPT SICKLE CELL CRISIS AND COAGULATION DISORDERS WITHOUT CC/MCC,810,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RED BLOOD CELL DISORDERS WITH MCC,811,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RED BLOOD CELL DISORDERS WITHOUT MCC,812,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
COAGULATION DISORDERS,813,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH MCC,814,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITH CC,815,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RETICULOENDOTHELIAL AND IMMUNITY DISORDERS WITHOUT CC/MCC,816,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH MCC,817,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITH CC,818,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER ANTEPARTUM DIAGNOSES WITH O.R. PROCEDURES WITHOUT CC/MCC,819,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH MCC,820,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITH CC,821,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LYMPHOMA AND LEUKEMIA WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,822,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH MCC,823,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITH CC,824,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH OTHER PROCEDURES WITHOUT CC/MCC,825,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH MCC,826,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITH CC,827,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH MAJOR O.R. PROCEDURES WITHOUT CC/MCC,828,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITH CC/MCC,829,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASMS WITH OTHER PROCEDURES WITHOUT CC/MCC,830,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH MCC,831,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITH CC,832,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER ANTEPARTUM DIAGNOSES WITHOUT O.R. PROCEDURES WITHOUT CC/MCC,833,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ACUTE LEUKEMIA WITH MCC,834,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ACUTE LEUKEMIA WITH CC,835,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ACUTE LEUKEMIA WITHOUT CC/MCC,836,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS OR WITH HIGH DOSE CHEMOTHERAPY AGENT WITH MCC,837,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC OR HIGH DOSE CHEMOTHERAPY AGENT,838,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CHEMOTHERAPY WITH ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,839,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH MCC,840,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITH CC,841,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
LYMPHOMA AND NON-ACUTE LEUKEMIA WITHOUT CC/MCC,842,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH MCC,843,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITH CC,844,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER MYELOPROLIFERATIVE DISORDERS OR POORLY DIFFERENTIATED NEOPLASTIC DIAGNOSES WITHOUT CC/MCC,845,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH MCC,846,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITH CC,847,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CHEMOTHERAPY WITHOUT ACUTE LEUKEMIA AS SECONDARY DIAGNOSIS WITHOUT CC/MCC,848,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
RADIOTHERAPY,849,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH MCC,853,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITH CC,854,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
INFECTIOUS AND PARASITIC DISEASES WITH O.R. PROCEDURES WITHOUT CC/MCC,855,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH MCC,856,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITH CC,857,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
POSTOPERATIVE OR POST-TRAUMATIC INFECTIONS WITH O.R. PROCEDURES WITHOUT CC/MCC,858,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITH MCC,862,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
POSTOPERATIVE AND POST-TRAUMATIC INFECTIONS WITHOUT MCC,863,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
FEVER AND INFLAMMATORY CONDITIONS,864,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
VIRAL ILLNESS WITH MCC,865,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
VIRAL ILLNESS WITHOUT MCC,866,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH MCC,867,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITH CC,868,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER INFECTIOUS AND PARASITIC DISEASES DIAGNOSES WITHOUT CC/MCC,869,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SEPTICEMIA OR SEVERE SEPSIS WITH MV >96 HOURS,870,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITH MCC,871,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SEPTICEMIA OR SEVERE SEPSIS WITHOUT MV >96 HOURS WITHOUT MCC,872,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
O.R. PROCEDURES WITH PRINCIPAL DIAGNOSIS OF MENTAL ILLNESS,876,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
ACUTE ADJUSTMENT REACTION AND PSYCHOSOCIAL DYSFUNCTION,880,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DEPRESSIVE NEUROSES,881,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NEUROSES EXCEPT DEPRESSIVE,882,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
DISORDERS OF PERSONALITY AND IMPULSE CONTROL,883,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ORGANIC DISTURBANCES AND INTELLECTUAL DISABILITY,884,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
PSYCHOSES,885,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
BEHAVIORAL AND DEVELOPMENTAL DISORDERS,886,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER MENTAL DISORDER DIAGNOSES,887,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE, LEFT AMA",894,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITH REHABILITATION THERAPY",895,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITH MCC",896,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"ALCOHOL, DRUG ABUSE OR DEPENDENCE WITHOUT REHABILITATION THERAPY WITHOUT MCC",897,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
WOUND DEBRIDEMENTS FOR INJURIES WITH MCC,901,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
WOUND DEBRIDEMENTS FOR INJURIES WITH CC,902,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
WOUND DEBRIDEMENTS FOR INJURIES WITHOUT CC/MCC,903,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SKIN GRAFTS FOR INJURIES WITH CC/MCC,904,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
SKIN GRAFTS FOR INJURIES WITHOUT CC/MCC,905,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HAND PROCEDURES FOR INJURIES,906,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER O.R. PROCEDURES FOR INJURIES WITH MCC,907,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER O.R. PROCEDURES FOR INJURIES WITH CC,908,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER O.R. PROCEDURES FOR INJURIES WITHOUT CC/MCC,909,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
TRAUMATIC INJURY WITH MCC,913,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
TRAUMATIC INJURY WITHOUT MCC,914,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ALLERGIC REACTIONS WITH MCC,915,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
ALLERGIC REACTIONS WITHOUT MCC,916,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
POISONING AND TOXIC EFFECTS OF DRUGS WITH MCC,917,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
POISONING AND TOXIC EFFECTS OF DRUGS WITHOUT MCC,918,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
COMPLICATIONS OF TREATMENT WITH MCC,919,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
COMPLICATIONS OF TREATMENT WITH CC,920,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
COMPLICATIONS OF TREATMENT WITHOUT CC/MCC,921,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITH MCC",922,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
"OTHER INJURY, POISONING AND TOXIC EFFECT DIAGNOSES WITHOUT MCC",923,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITH SKIN GRAFT,927,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITH CC/MCC,928,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
FULL THICKNESS BURN WITH SKIN GRAFT OR INHALATION INJURY WITHOUT CC/MCC,929,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
EXTENSIVE BURNS OR FULL THICKNESS BURNS WITH MV >96 HOURS WITHOUT SKIN GRAFT,933,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
FULL THICKNESS BURN WITHOUT SKIN GRAFT OR INHALATION INJURY,934,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
NON-EXTENSIVE BURNS,935,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH MCC,939,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITH CC,940,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
O.R. PROCEDURES WITH DIAGNOSES OF OTHER CONTACT WITH HEALTH SERVICES WITHOUT CC/MCC,941,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
REHABILITATION WITH CC/MCC,945,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
REHABILITATION WITHOUT CC/MCC,946,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SIGNS AND SYMPTOMS WITH MCC,947,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
SIGNS AND SYMPTOMS WITHOUT MCC,948,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
AFTERCARE WITH CC/MCC,949,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
AFTERCARE WITHOUT CC/MCC,950,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER FACTORS INFLUENCING HEALTH STATUS,951,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
CRANIOTOMY FOR MULTIPLE SIGNIFICANT TRAUMA,955,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
"LIMB REATTACHMENT, HIP AND FEMUR PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA",956,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH MCC,957,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITH CC,958,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER O.R. PROCEDURES FOR MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,959,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH MCC,963,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITH CC,964,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
OTHER MULTIPLE SIGNIFICANT TRAUMA WITHOUT CC/MCC,965,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
HIV WITH EXTENSIVE O.R. PROCEDURES WITH MCC,969,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HIV WITH EXTENSIVE O.R. PROCEDURES WITHOUT MCC,970,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
HIV WITH MAJOR RELATED CONDITION WITH MCC,974,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
HIV WITH MAJOR RELATED CONDITION WITH CC,975,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
HIV WITH MAJOR RELATED CONDITION WITHOUT CC/MCC,976,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
HIV WITH OR WITHOUT OTHER RELATED CONDITION,977,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,981,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,982,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,983,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH MCC,987,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITH CC,988,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
NON-EXTENSIVE O.R. PROCEDURES UNRELATED TO PRINCIPAL DIAGNOSIS WITHOUT CC/MCC,989,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,case rate,100% of CMS IPPS Rate,3907,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,3907,3907,
PRINCIPAL DIAGNOSIS INVALID AS DISCHARGE DIAGNOSIS,998,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,
UNGROUPABLE,999,CDM,100,RC,,,Outpatient,,,,,,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,case rate,100% of CMS IPPS Rate,2945,100,,,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,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,,,,,other ,not seperately reimbursable,2945,2945,